Healthcare Provider Details

I. General information

NPI: 1891626594
Provider Name (Legal Business Name): MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL DRIVE STE 300
PRINCE FREDERICK MD
20678-4057
US

IV. Provider business mailing address

24035 THREE NOTCH RD
HOLLYWOOD MD
20636-4871
US

V. Phone/Fax

Practice location:
  • Phone: 301-373-7900
  • Fax: 301-373-6900
Mailing address:
  • Phone: 301-373-7900
  • Fax: 301-373-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN ADAIR BUSTER JR.
Title or Position: C.O.O.
Credential:
Phone: 301-373-7905