Provider Demographics
NPI:1225872740
Name:MARYLAND CHILDREN HEALTH CENTER
Entity type:Organization
Organization Name:MARYLAND CHILDREN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-218-0398
Mailing Address - Street 1:12150 ANNAPOLIS RD STE 208
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9183
Mailing Address - Country:US
Mailing Address - Phone:301-218-0398
Mailing Address - Fax:
Practice Address - Street 1:12150 ANNAPOLIS RD STE 208
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:301-218-0398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY OGUNSANYA MD FAAP MARYLAND CHILDREN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care