Provider Demographics
NPI:1285691527
Name:PRINCE GEORGE'S COUNTY MARYLAND
Entity type:Organization
Organization Name:PRINCE GEORGE'S COUNTY MARYLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY FIRE CHIEF -EMS
Authorized Official - Prefix:
Authorized Official - First Name:WARREN 'TONY'
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-883-5210
Mailing Address - Street 1:PO BOX 719325
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-9325
Mailing Address - Country:US
Mailing Address - Phone:844-333-6768
Mailing Address - Fax:833-953-0588
Practice Address - Street 1:9201 BASIL CT STE 452
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5343
Practice Address - Country:US
Practice Address - Phone:301-883-5240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD428628600Medicaid
MD1992 0001OtherBC OF NATL CAPITAL AREA
MD1992 0001OtherBC OF NATL CAPITAL AREA