Provider Demographics
NPI: | 1881917441 |
---|---|
Name: | PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT |
Entity type: | Organization |
Organization Name: | PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER, CLIENT INFORMATION SERVICE |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | DARLENE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WHITAKER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 301-883-7861 |
Mailing Address - Street 1: | 3003 HOSPITAL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | CHEVERLY |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20785-1194 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1701 MCCORMICK DR |
Practice Address - Street 2: | |
Practice Address - City: | LARGO |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20774-5329 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-883-7868 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-03-10 |
Last Update Date: | 2010-03-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251K00000X | Agencies | Public Health or Welfare |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 234843800 | Medicare PIN |