Provider Demographics
NPI:1871903054
Name:MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Entity type:Organization
Organization Name:MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-877-4530
Mailing Address - Street 1:7501 SURRATTS RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3362
Mailing Address - Country:US
Mailing Address - Phone:301-877-7202
Mailing Address - Fax:301-877-7253
Practice Address - Street 1:7501 SURRATTS RD
Practice Address - Street 2:SUITE 305
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3362
Practice Address - Country:US
Practice Address - Phone:301-877-7202
Practice Address - Fax:301-877-7253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty