Provider Demographics
NPI:1982753877
Name:MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Entity Type:Organization
Organization Name:MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Other - Org Name:PEDIATRIC AFTER HOURS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-856-3019
Mailing Address - Street 1:10403 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE G-04
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3134
Mailing Address - Country:US
Mailing Address - Phone:301-868-8024
Mailing Address - Fax:301-856-9370
Practice Address - Street 1:10 SAINT PATRICKS DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4519
Practice Address - Country:US
Practice Address - Phone:301-645-1414
Practice Address - Fax:301-645-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty