Healthcare Provider Details

I. General information

NPI: 1942099510
Provider Name (Legal Business Name): PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HOSPITAL DR
CHEVERLY MD
20785-1194
US

IV. Provider business mailing address

1701 MCCORMICK DR
LARGO MD
20774-5329
US

V. Phone/Fax

Practice location:
  • Phone: 301-883-7879
  • Fax: 301-883-7890
Mailing address:
  • Phone: 240-302-8576
  • Fax: 301-883-7890

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: TAMALA BUTLER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 240-302-8576