NPIMap

Organization Active NPI

Medstar Southern Maryland Physicians, LLC

Doing business as Waldorf Family Medical Center

  • Family Medicine Physician
  • Waldorf, MD
National Provider Identifier
1780629683
Registry record updated Mar 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Doing business as
Waldorf Family Medical Center
Practice address
10 St Patricks Drive
Suite 203
Waldorf, MD 20603-4527
Phone
(301) 843-0222
Fax
(301) 843-0651
NPI assigned
Jun 17, 2006
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
Vice President
Phone
(301) 856-3019

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

10 St Patricks Drive
Suite 203
Waldorf, MD 20603-4527

Mailing address

10403 Hospital Drive
Suite G-4
Clinton, MD 20735-3134
Phone (301) 856-3019

Other names 1

  • Waldorf Family Medical Center 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

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": "1780629683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10403 HOSPITAL DRIVE",
            "address_2": "SUITE G-4",
            "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": "10 ST PATRICKS DRIVE",
            "address_2": "SUITE 203",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034527",
            "telephone_number": "301-843-0222",
            "fax_number": "301-843-0651"
        }
    ],
    "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waldorf Family Medical Center",
            "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.