1366897225 NPI number — PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1366897225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366897225 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:
1366897225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 UNIVERSITY BLVD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYATTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20783-4029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-434-4890
Provider Business Mailing Address Fax Number:
301-434-4896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 UNIVERSITY BLVD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYATTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20783-4029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-434-4890
Provider Business Practice Location Address Fax Number:
301-434-4896
Provider Enumeration Date:
04/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DOSS
Authorized Official First Name:
WRIGHT
Authorized Official Middle Name:
F
Authorized Official Title or Position:
ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
301-883-3505

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com