Provider Demographics
NPI:1932245883
Name:PRINCE GEORGE'S COUNTY HEALTH DEPT
Entity type:Organization
Organization Name:PRINCE GEORGE'S COUNTY HEALTH DEPT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOLARIK
Authorized Official - Suffix:
Authorized Official - Credentials:DCSW-C
Authorized Official - Phone:301-883-3510
Mailing Address - Street 1:1801 MCCORMICK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5370
Mailing Address - Country:US
Mailing Address - Phone:301-583-0366
Mailing Address - Fax:
Practice Address - Street 1:1801 MCCORMICK DR STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5370
Practice Address - Country:US
Practice Address - Phone:301-583-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903170251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare