1427251966 NPI number — PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427251966 NPI number — PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427251966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 MCCORMICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-5329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-883-7861
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 MCCORMICK DR
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20774-5326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-883-3524
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITAKER
Authorized Official First Name:
DARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER REVENUE
Authorized Official Telephone Number:
301-883-7861

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 74003 . This is a "COLORECTAL CANCER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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