NPIMap

Organization Active NPI

Medstar Southern Maryland Physicians, LLC

  • Otolaryngology Physician
  • Clinton, MD
National Provider Identifier
1497790398
Registry record updated Mar 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Practice address
10401 Hospital Drive
Suite G-4
Clinton, MD 20735-3134
Phone
(301) 877-0891
Fax
(301) 856-0536
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2013

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

Authorized official

Name
Jane Raymond
Title
Vice President
Phone
(301) 856-3019

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

10401 Hospital Drive
Suite G-4
Clinton, MD 20735-3134

Mailing address

10403 Hospital Drive
Suite G-04
Clinton, MD 20735-3134
Phone (301) 856-3019

Other names 1

  • Clinton ENT Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medstar Southern MD Phys13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

10401 Hospital Dr
Ste G4
Clinton, MD 20735
Phone (301) 877-0891

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363305600000",
    "number": "1497790398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10403 HOSPITAL DRIVE",
            "address_2": "SUITE G-04",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353134",
            "telephone_number": "301-856-3019",
            "fax_number": "301-856-9370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10401 HOSPITAL DRIVE",
            "address_2": "SUITE G-4",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353134",
            "telephone_number": "301-877-0891",
            "fax_number": "301-856-0536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2013-03-15",
        "status": "A",
        "authorized_official_last_name": "RAYMOND",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "301-856-3019"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinton ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2013; 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.