NPIMap

Organization Active NPI

Medstar Southern Maryland Physicians, LLC

Doing business as Waldorf ENT

  • Otolaryngology Physician
  • Waldorf, MD
National Provider Identifier
1598060709
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
Doing business as
Waldorf ENT
Practice address
10 Saint Patricks Dr
Suite 202
Waldorf, MD 20603-4527
Phone
(301) 396-8071
Fax
(301) 396-4671
NPI assigned
Jan 19, 2011
Last updated
Mar 15, 2013By the provider in NPPES
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
VP
Phone
(301) 868-3019

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD Primary

Addresses

Primary practice location

10 Saint Patricks Dr
Suite 202
Waldorf, MD 20603-4527

Mailing address

10403 Hospital Dr
Suite G4
Clinton, MD 20735-3134
Phone (301) 868-3019

Other names 1

  • WALDORF 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

10403 Hospital Dr
Ste G4
Clinton, MD 20735
Phone (301) 856-3019

7501 Surratts Rd
Ste 208B
Clinton, MD 20735
Phone (301) 856-1075

12825 Old Fort Rd
Ft Washington, MD 20744
Phone (301) 292-4440

950 E Swan Creek Rd
Ft Washington, MD 20744
Phone (301) 292-0236

10 Saint Patricks Dr
#202
Waldorf, MD 20603
Phone (301) 396-8071

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363305600000",
    "number": "1598060709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10403 HOSPITAL DR",
            "address_2": "SUITE G4",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353134",
            "telephone_number": "301-868-3019",
            "fax_number": "301-856-9370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SAINT PATRICKS DR",
            "address_2": "SUITE 202",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034527",
            "telephone_number": "301-396-8071",
            "fax_number": "301-396-4671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2013-03-15",
        "status": "A",
        "authorized_official_last_name": "RAYMOND",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "301-868-3019"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALDORF ENT",
            "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 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.