Healthcare Provider Details

I. General information

NPI: 1932254299
Provider Name (Legal Business Name): PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 HAMPTON PARK BLVD.
CAPITOL HEIGHTS MD
20743-3802
US

IV. Provider business mailing address

1701 MCCORMICK DR
LARGO MD
20774-5329
US

V. Phone/Fax

Practice location:
  • Phone: 301-324-2872
  • Fax: 301-324-2850
Mailing address:
  • Phone: 301-324-2872
  • Fax: 301-324-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: BARBARA ANN BANKS-WIGGINS
Title or Position: PROJECT MANAGER
Credential:
Phone: 301-883-7861