NPIMap

Organization Active NPI

Old Line Medical Services, P.C.

  • Health Service Clinic/Center
  • Waldorf, MD
National Provider Identifier
1164580635
Registry record updated Jul 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
OLD LINE MEDICAL SERVICES, P.C.
Practice address
12090 Old Line Ctr
Waldorf, MD 20602-2556
Phone
(301) 843-3888
Fax
(301) 870-6838
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephen Edward Wiggins, M.D.
Title
President
Phone
(301) 843-3888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X MD Primary

Addresses

Primary practice location

12090 Old Line Ctr
Waldorf, MD 20602-2556

Mailing address

12090 Old Line Ctr
Waldorf, MD 20602-2556
Phone (301) 843-3888

Other names 1

  • Convenient Health Care Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279152000000",
    "number": "1164580635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12090 OLD LINE CTR",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022556",
            "telephone_number": "301-843-3888",
            "fax_number": "301-870-6838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12090 OLD LINE CTR",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022556",
            "telephone_number": "301-843-3888",
            "fax_number": "301-870-6838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD LINE MEDICAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2010-07-15",
        "status": "A",
        "authorized_official_last_name": "WIGGINS",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-843-3888",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Convenient Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.