Active NPI
Southern Maryland Hospital, Inc
- Psychiatry Physician
- Clinton, MD
National Provider Identifier
1053500678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- Legal business name
- SOUTHERN MARYLAND HOSPITAL, INC
- Doing business as
- Department of Psychiatry
- Practice address
- 7503 Surratts Road
Clinton, MD 20735-3358 - Phone
- (301) 870-7001
- Fax
- (301) 870-6697
- NPI assigned
- Oct 19, 2007
- Organization subpart
- Yes
- Parent organization
- SOUTHERN MARYLAND HOSPITAL, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Charles R. Stewart
- Title
- Cfo
- Phone
- (301) 877-4541
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | Primary |
Addresses
Primary practice location
7503 Surratts Road
Clinton, MD 20735-3358
Mailing address
7503 Surratts Road
Clinton, MD 20735-3358
Phone (301) 870-7001
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 412957100 | Medicaid | MD | |
| H890, 0002 | Other | MD | CAREFIRST NCA & MARYLAND |
Other names 1
- Department of Psychiatry
National Provider Directory
National Provider Directory- Part of
- Sothern Maryland Hospit
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192752000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1320624000000",
"number": "1053500678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7503 SURRATTS ROAD",
"city": "CLINTON",
"state": "MD",
"postal_code": "207353358",
"telephone_number": "301-870-7001",
"fax_number": "301-870-6697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7503 SURRATTS ROAD",
"city": "CLINTON",
"state": "MD",
"postal_code": "207353358",
"telephone_number": "301-870-7001",
"fax_number": "301-870-6697"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHERN MARYLAND HOSPITAL, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SOUTHERN MARYLAND HOSPITAL, INC.",
"enumeration_date": "2007-10-19",
"last_updated": "2011-11-07",
"status": "A",
"authorized_official_last_name": "STEWART",
"authorized_official_first_name": "CHARLES",
"authorized_official_middle_name": "R.",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "301-877-4541",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "412957100",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST NCA & MARYLAND",
"identifier": "H890, 0002",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Department of Psychiatry",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Clinton, MD
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.