NPIMap

Organization Active NPI

Waldorf Primary Care LLC

  • Primary Care Clinic/Center
  • Waldorf, MD
National Provider Identifier
1356598379
Registry record updated Nov 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
D0066434 Issued in MD
Legal business name
WALDORF PRIMARY CARE LLC
Practice address
3460 Old Washington Rd
Suite 103
Waldorf, MD 20602-3240
Phone
(301) 638-0001
Fax
(301) 638-5454
NPI assigned
Aug 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2008

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

Authorized official

Name
Dr. Karlene Vanessa Ross, MD
Title
Medical Director
Phone
(301) 638-0001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X D0066434 MD Primary

Addresses

Primary practice location

3460 Old Washington Rd
Suite 103
Waldorf, MD 20602-3240

Mailing address

3460 Old Washington Rd
Suite 103
Waldorf, MD 20602-3240
Phone (301) 638-0001

National Provider Directory

National Provider Directory

Locations

3460 Old Washington Rd
Ste 103
Waldorf, MD 20602
Phone (301) 638-0001

NPI Registry JSON

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227139200000",
    "number": "1356598379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3460 OLD WASHINGTON RD",
            "address_2": "SUITE 103",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023240",
            "telephone_number": "301-638-0001",
            "fax_number": "301-638-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 OLD WASHINGTON RD",
            "address_2": "SUITE 103",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023240",
            "telephone_number": "301-638-0001",
            "fax_number": "301-638-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALDORF PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-20",
        "last_updated": "2008-11-20",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "KARLENE",
        "authorized_official_middle_name": "VANESSA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "301-638-0001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D0066434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Nov 20, 2008; 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.