1528340197 NPI number — PRINCE GEORGES OBGYN ASSOCIATES PA

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 1528340197 NPI number — PRINCE GEORGES OBGYN ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCE GEORGES OBGYN ASSOCIATES PA
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:
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:
1528340197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8214 TUCKERMAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20854-3744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-983-9366
Provider Business Mailing Address Fax Number:
301-983-3283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4333 OLD BRANCH AVE
Provider Second Line Business Practice Location Address:
SUITE PG1
Provider Business Practice Location Address City Name:
TEMPLE HILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20748-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-983-9366
Provider Business Practice Location Address Fax Number:
301-983-3283
Provider Enumeration Date:
09/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BLAKE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-983-9366

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  D0030235 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com