1063101731 NPI number — ST. MARY'S COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1063101731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063101731 NPI number — ST. MARY'S COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY'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:
1063101731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21580 PEABODY STREET PO BOX 316
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEONARDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20650-0316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29675 POINT LOOKOUT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-434-6060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BREWSTER
Authorized Official First Name:
MEENAKSHI
Authorized Official Middle Name:
GARG
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
301-475-4317

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com