NPIMap

Organization Active NPI

Medstar Medical Group - Southern Maryland LLC

  • Internal Medicine Physician
  • Hollywood, MD
National Provider Identifier
1831592211
Registry record updated Mar 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC
Practice address
24035 Three Notch Road
Hollywood, MD 20636-4871
Phone
(301) 373-7900
Fax
(301) 373-6900
NPI assigned
Sep 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

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

Authorized official

Name
Eric R Wagner
Title
Executive Vice President
Phone
(410) 772-6595

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X

Addresses

Primary practice location

24035 Three Notch Road
Hollywood, MD 20636-4871

Mailing address

24035 Three Notch Rd
Hollywood, MD 20636-4871
Phone (301) 373-7900

Other practice location 1

952 E Swann Creek Road
Fort Washington, MD 20744-1124
Phone (301) 292-7270

Other practice location 2

7501 Greenway Center Drive Suite 500
Greenbelt, MD 20770-3546
Phone (301) 779-5106

Other practice location 3

7300 Hanover Drive Suite 202
Greenbelt, MD 20770-2247
Phone (301) 441-1557

Other practice location 4

26840 Point Lookout Road
Leonardtown, MD 20650-0664
Phone (301) 475-5577

Other practice location 5

4240 Altamont Place
White Plains, MD 20695-3052
Phone (240) 518-6020

Other practice location 6

23415 Three Notch Rd 2051
California, MD 20619-4018
Phone (301) 373-7800

Other practice location 7

10 Saint Patricks Dr
Waldorf, MD 20603-4527
Phone (301) 373-7900

Other practice location 8

130 Hospital Rd Ste 300
Prince Frederick, MD 20678-4057
Phone (410) 535-4333

Other practice location 9

9811 Greenbelt Rd Ste 104
Lanham, MD 20706-6241
Phone (301) 373-7900

Other practice location 10

108 Forbes St 2nd Floor
Annapolis, MD 21401-1502
Phone (410) 571-7880

Other practice location 11

10403 Hospital Dr 102
Clinton, MD 20735-3134
Phone (301) 531-9190

Other practice location 12

22590 Shady Court
California, MD 20619-5009
Phone (301) 737-0500

Other practice location 13

37767 Market Dr 2nd Floor
Charlotte Hall, MD 20622-3188
Phone (301) 884-7330

Other practice location 14

1015 Prince Frederick Blvd
Prince Frederick, MD 20678-3193
Phone (410) 535-4116

Other practice location 15

22650 Cedar Lane Ct
Leonardtown, MD 20650-3965
Phone (301) 475-5021

Other practice location 16

28030 Old Village Road
Mechanicsville, MD 20659-3295
Phone (301) 884-4666

Other practice location 17

6710 Oxon Hill Road Suite 250
Oxon Hill, MD 20745-1124
Phone (301) 292-7270

Other practice location 18

11910 HG Trueman Road
Lsuby, MD 20657-2921
Phone (410) 326-6391

Other practice location 19

950 E Swann Creek Rd
Ft Washington, MD 20744-5250
Phone (301) 292-7270

Other practice location 20

900 East Swann Creek Road
Ft Washington, MD 20744-5250
Phone (301) 292-1590

Other practice location 21

7704 Matapeake Business Dr Suite 325
Brandywine, MD 20613-3043
Phone (240) 244-5151

Other practice location 22

2200 Defense Hwy Suite 103
Crofton, MD 21114-2926
Phone (410) 721-5280

Other practice location 23

14300 Gallant Fox Lane Suite 123
Bowie, MD 20715-1001
Phone (301) 860-1310

Other practice location 24

10583 Theodore Green Blvd
White Plains, MD 20695-3022
Phone (301) 934-9300

Other names 1

  • MedStar Shah Medical Group, LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20150223001281 MD Part B Supplier - Clinic/Group Practice 1355667056 Receives reassigned benefits from 304 practitioners
Practice locations: White Plains, MD; Waldorf, MD; Hollywood, MD; Prince Frederick, MD; Mechanicsville, MD; Leonardtown, MD; Crofton, MD; Charlotte Hall, MD…
O20150312000328 DC Part B Supplier - Clinic/Group Practice 1355667056 Receives reassigned benefits from 170 practitioners
Practice locations: Greenbelt, MD; Riverdale, MD; Oxon Hill, MD; Lanham, MD; Ft Washington, MD; Fort Washington, MD; Bowie, MD; Brandywine, MD…
O20150324000779 MD Part B Supplier - Ambulatory Surgical Center 1355667056 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hollywood, MD; Prince Frederick, MD; Waldorf, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D0926884Medstar Shah Medical Group Philip J Bean Med Ctr24035 Three Notch Road, Hollywood, MD 20636ComplianceOct 27, 2027

National Provider Directory

National Provider Directory

Locations

23415 Three Notch Rd
Ste 2051
California, MD 20619
Phone (301) 373-7700

10403 Hospital Dr
Clinton, MD 20735
Phone (301) 856-0050

2200 Defense Hwy
Ste 103
Crofton, MD 21114
Phone (410) 721-5280

952 E Swan Creek Rd
Ste A
Fort Washington, MD 20744

952 E Swan Creek Rd
Ft Washington, MD 20744

11707 Livingston Rd
Ste 306
Ft Washington, MD 20744
Phone (301) 705-7870

7237 Hanover Pkwy
Ste A
Greenbelt, MD 20770
Phone (301) 345-3232

12070 Old Line Ctr
Ste 100
Waldorf, MD 20602
Phone (301) 705-7870

10 Saint Patricks Dr
Fl 3
Waldorf, MD 20603
Phone (240) 448-2970

4240 Altamont Pl
White Plains, MD 20695
Phone (240) 518-6020

Practitioners & affiliated clinicians

Practitioners 319

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

View all 319

NPI Registry JSON

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

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773273600000",
    "number": "1831592211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24035 THREE NOTCH RD",
            "city": "HOLLYWOOD",
            "state": "MD",
            "postal_code": "206364871",
            "telephone_number": "301-373-7900",
            "fax_number": "301-373-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24035 THREE NOTCH ROAD",
            "city": "HOLLYWOOD",
            "state": "MD",
            "postal_code": "206364871",
            "telephone_number": "301-373-7900",
            "fax_number": "301-373-6900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "952 E Swann Creek Road",
            "address_purpose": "LOCATION",
            "city": "Fort Washington",
            "state": "MD",
            "postal_code": "207441124",
            "country_code": "US",
            "telephone_number": "301-292-7270",
            "fax_number": "301-747-9106",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7501 Greenway Center Drive Suite 500",
            "address_purpose": "LOCATION",
            "city": "Greenbelt",
            "state": "MD",
            "postal_code": "207703546",
            "country_code": "US",
            "telephone_number": "301-779-5106",
            "fax_number": "301-779-5109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7300 Hanover Drive Suite 202",
            "address_purpose": "LOCATION",
            "city": "Greenbelt",
            "state": "MD",
            "postal_code": "207702247",
            "country_code": "US",
            "telephone_number": "301-441-1557",
            "fax_number": "301-345-1835",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "26840 Point Lookout Road",
            "address_purpose": "LOCATION",
            "city": "Leonardtown",
            "state": "MD",
            "postal_code": "206500664",
            "country_code": "US",
            "telephone_number": "301-475-5577",
            "fax_number": "301-475-7419",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4240 Altamont Place",
            "address_purpose": "LOCATION",
            "city": "White Plains",
            "state": "MD",
            "postal_code": "206953052",
            "country_code": "US",
            "telephone_number": "240-518-6020",
            "fax_number": "240-518-6021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "23415 THREE NOTCH RD 2051",
            "address_purpose": "LOCATION",
            "city": "California",
            "state": "MD",
            "postal_code": "206194018",
            "country_code": "US",
            "telephone_number": "301-373-7800",
            "fax_number": "301-373-6800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 Saint Patricks Dr",
            "address_purpose": "LOCATION",
            "city": "Waldorf",
            "state": "MD",
            "postal_code": "206034527",
            "country_code": "US",
            "telephone_number": "301-373-7900",
            "fax_number": "301-373-6900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Hospital Rd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Prince Frederick",
            "state": "MD",
            "postal_code": "206784057",
            "country_code": "US",
            "telephone_number": "410-535-4333",
            "fax_number": "410-535-3260",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9811 Greenbelt Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Lanham",
            "state": "MD",
            "postal_code": "207066241",
            "country_code": "US",
            "telephone_number": "301-373-7900",
            "fax_number": "301-373-6900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "108 Forbes St 2nd Floor",
            "address_purpose": "LOCATION",
            "city": "Annapolis",
            "state": "MD",
            "postal_code": "214011502",
            "country_code": "US",
            "telephone_number": "410-571-7880",
            "fax_number": "109-406-5384",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10403 Hospital Dr 102",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "MD",
            "postal_code": "207353134",
            "country_code": "US",
            "telephone_number": "301-531-9190",
            "fax_number": "301-531-9191",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22590 SHADY COURT",
            "address_purpose": "LOCATION",
            "city": "California",
            "state": "MD",
            "postal_code": "206195009",
            "country_code": "US",
            "telephone_number": "301-737-0500",
            "fax_number": "301-373-3351",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "37767 Market Dr 2nd Floor",
            "address_purpose": "LOCATION",
            "city": "Charlotte Hall",
            "state": "MD",
            "postal_code": "206223188",
            "country_code": "US",
            "telephone_number": "301-884-7330",
            "fax_number": "301-884-7530",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1015 Prince Frederick Blvd",
            "address_purpose": "LOCATION",
            "city": "Prince Frederick",
            "state": "MD",
            "postal_code": "206783193",
            "country_code": "US",
            "telephone_number": "410-535-4116",
            "fax_number": "410-414-8480",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22650 Cedar Lane Ct",
            "address_purpose": "LOCATION",
            "city": "Leonardtown",
            "state": "MD",
            "postal_code": "206503965",
            "country_code": "US",
            "telephone_number": "301-475-5021",
            "fax_number": "301-997-0264",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "28030 Old Village Road",
            "address_purpose": "LOCATION",
            "city": "Mechanicsville",
            "state": "MD",
            "postal_code": "206593295",
            "country_code": "US",
            "telephone_number": "301-884-4666",
            "fax_number": "301-884-5852",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6710 Oxon Hill Road Suite 250",
            "address_purpose": "LOCATION",
            "city": "Oxon Hill",
            "state": "MD",
            "postal_code": "207451124",
            "country_code": "US",
            "telephone_number": "301-292-7270",
            "fax_number": "301-203-0740",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11910 HG Trueman Road",
            "address_purpose": "LOCATION",
            "city": "Lsuby",
            "state": "MD",
            "postal_code": "206572921",
            "country_code": "US",
            "telephone_number": "410-326-6391",
            "fax_number": "410-326-6399",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "950 E Swann Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Ft Washington",
            "state": "MD",
            "postal_code": "207445250",
            "country_code": "US",
            "telephone_number": "301-292-7270",
            "fax_number": "301-292-6432",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 East Swann Creek Road",
            "address_purpose": "LOCATION",
            "city": "Ft Washington",
            "state": "MD",
            "postal_code": "207445250",
            "country_code": "US",
            "telephone_number": "301-292-1590",
            "fax_number": "301-861-1210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7704 Matapeake Business Dr Suite 325",
            "address_purpose": "LOCATION",
            "city": "Brandywine",
            "state": "MD",
            "postal_code": "206133043",
            "country_code": "US",
            "telephone_number": "240-244-5151",
            "fax_number": "240-244-5131",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 Defense Hwy Suite 103",
            "address_purpose": "LOCATION",
            "city": "Crofton",
            "state": "MD",
            "postal_code": "211142926",
            "country_code": "US",
            "telephone_number": "410-721-5280",
            "fax_number": "410-721-2243",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14300 Gallant Fox Lane Suite 123",
            "address_purpose": "LOCATION",
            "city": "Bowie",
            "state": "MD",
            "postal_code": "207151001",
            "country_code": "US",
            "telephone_number": "301-860-1310",
            "fax_number": "301-860-1331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10583 Theodore Green Blvd",
            "address_purpose": "LOCATION",
            "city": "White Plains",
            "state": "MD",
            "postal_code": "206953022",
            "country_code": "US",
            "telephone_number": "301-934-9300",
            "fax_number": "301-934-6963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-30",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "410-772-6595"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedStar Shah Medical Group, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.