Healthcare Provider Details

I. General information

NPI: 1427251966
Provider Name (Legal Business Name): PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 MCCORMICK DR SUITE 260
LARGO MD
20774-5326
US

IV. Provider business mailing address

1701 MCCORMICK DR
LARGO MD
20774-5329
US

V. Phone/Fax

Practice location:
  • Phone: 301-883-3524
  • Fax:
Mailing address:
  • Phone: 301-883-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier74003
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCOLORECTAL CANCER

VIII. Authorized Official

Name: MS. DARLENE WHITAKER
Title or Position: MANAGER REVENUE
Credential:
Phone: 301-883-7861