Provider Demographics
NPI:1841377728
Name:CHARLES COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CHARLES COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-609-2535
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:4545 CRAIN HIGHWAY
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-1050
Mailing Address - Country:US
Mailing Address - Phone:301-609-6928
Mailing Address - Fax:301-609-6939
Practice Address - Street 1:4545 CRAIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-1050
Practice Address - Country:US
Practice Address - Phone:301-609-6928
Practice Address - Fax:301-609-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9591251S00000X
MD9634251S00000X
MD251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265581100Medicaid
MD703071100Medicaid
MD730323800Medicaid
MD041843900Medicaid
MD776463400Medicaid
MD703071100Medicaid