NPIMap

Organization Active NPI

George H Wathen MD PA

  • Specialist
  • Waldorf, MD
National Provider Identifier
1710168836
Registry record updated Feb 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
D0020629 Issued in MD
Legal business name
GEORGE H WATHEN MD PA
Practice address
Suite 103
11345 Pembrooke SQ
Waldorf, MD 20603-4804
Phone
(301) 645-8144
Fax
(301) 870-8392
NPI assigned
Nov 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2008

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

Authorized official

Name
George H Wathen, MD PANPI 1861453284
Title
President
Phone
(301) 645-8144

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X D0020629 MD Primary

Addresses

Primary practice location

Suite 103
11345 Pembrooke SQ
Waldorf, MD 20603-4804

Mailing address

11345 Pembrooke SQ
Suite 103
Waldorf, MD 20603-4804
Phone (301) 645-8144

Other identifiers 1

IdentifierTypeStateIssuer
DG5923OtherR R MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050803000390 MD Part B Supplier - Clinic/Group Practice 4385672070 Receives reassigned benefits from 1 practitioner
Practice locations: Laplata, MD; Waldorf, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1710168836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11345 PEMBROOKE SQ",
            "address_2": "SUITE 103",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034804",
            "telephone_number": "301-645-8144",
            "fax_number": "301-870-8392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUITE 103",
            "address_2": "11345 PEMBROOKE SQ",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034804",
            "telephone_number": "301-645-8144",
            "fax_number": "301-870-8392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE H WATHEN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2008-02-15",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-645-8144",
        "authorized_official_credential": "MD PA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MD",
            "license": "D0020629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R R MEDICARE",
            "identifier": "DG5923",
            "state": null
        }
    ],
    "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 Feb 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.