Provider Demographics
NPI:1316340201
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:V.P. 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 1:11340 PEMBROOKE SQ
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4808
Mailing Address - Country:US
Mailing Address - Phone:301-843-7737
Mailing Address - Fax:301-932-7917
Practice Address - Street 1:11340 PEMBROOKE SQ
Practice Address - Street 2:SUITE 203
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4808
Practice Address - Country:US
Practice Address - Phone:301-843-7737
Practice Address - Fax:301-932-7917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty