Provider Demographics
NPI:1194496703
Name:INTEGRARE HEALTH MARYLAND
Entity type:Organization
Organization Name:INTEGRARE HEALTH MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-412-2730
Mailing Address - Street 1:9500 MEDICAL CENTER DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-3703
Mailing Address - Country:US
Mailing Address - Phone:202-796-5000
Mailing Address - Fax:
Practice Address - Street 1:9500 MEDICAL CENTER DR STE 474
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3725
Practice Address - Country:US
Practice Address - Phone:202-796-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty