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Medstar Southern Maryland Physicians, LLC

Organization Active NPI Obstetrics & Gynecology Physician · Waldorf, MD

NPI 1316340201 · NPPES record last updated Oct 6, 2014

Key facts

NPI
1316340201
Entity type
Organization (NPI type 2)
Primary specialty
Obstetrics & Gynecology Physician 207V00000X
Legal business name
MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Practice address
11340 Pembrooke SQ
Suite 203
Waldorf, MD 20603-4808
Phone
(301) 843-7737
Fax
(301) 932-7917
NPI assigned
Oct 6, 2014
Organization subpart
Yes
Parent organization (as reported)
MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC

Authorized official

Name
Jane E. Raymond
Title
V.P. of Physician Services
Phone
(301) 877-4530

Corporate family (same tax ID) 12

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Medstar Southern MD Phys (13 organizations share this tax ID)
Part of
Medstar Southern MD Phys

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207V00000X Yes

Addresses

Primary practice location

11340 Pembrooke SQ
Suite 203
Waldorf, MD 20603-4808

Mailing address

11340 Pembrooke SQ
Suite 203
Waldorf, MD 20603-4808
Phone (301) 843-7737

Other names

  • MedStar Southern Maryland Women's Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 6, 2014.

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412553600000",
    "number": "1316340201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11340 PEMBROOKE SQ",
            "address_2": "SUITE 203",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034808",
            "telephone_number": "301-843-7737",
            "fax_number": "301-932-7917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11340 PEMBROOKE SQ",
            "address_2": "SUITE 203",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034808",
            "telephone_number": "301-843-7737",
            "fax_number": "301-932-7917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC",
        "enumeration_date": "2014-10-06",
        "last_updated": "2014-10-06",
        "status": "A",
        "authorized_official_last_name": "RAYMOND",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "V.P. OF PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "301-877-4530"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedStar Southern Maryland Women's Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waldorf, MD

All providers in Waldorf, MD · Obstetrics & Gynecology Physician in Maryland

Sources for this page

Verify at the official NPI Registry.