Healthcare Provider Details

I. General information

NPI: 1114749496
Provider Name (Legal Business Name): PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MCCORMICK DR
LARGO MD
20774-5329
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: 301-883-7879
  • Fax: 301-883-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MATTHEW D LEVY
Title or Position: HEALTH OFFICER
Credential:
Phone: 414-337-7883