Healthcare Provider Details

I. General information

NPI: 1669178018
Provider Name (Legal Business Name): SOUTHERN MARYLAND HOUSE CALLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45088 BLACKISTONE CIR
HOLLYWOOD MD
20636-2891
US

IV. Provider business mailing address

24351 MERVELL DEAN RD UNIT 161
HOLLYWOOD MD
20636-7507
US

V. Phone/Fax

Practice location:
  • Phone: 240-587-7275
  • Fax: 240-587-6600
Mailing address:
  • Phone: 240-587-7275
  • Fax: 240-587-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE ANNE SHEPARD
Title or Position: OWNER/PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 240-587-7275