Healthcare Provider Details

I. General information

NPI: 1841377728
Provider Name (Legal Business Name): CHARLES COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 CRAIN HIGHWAY
WHITE PLAINS MD
20695-1050
US

IV. Provider business mailing address

PO BOX 1050 4545 CRAIN HIGHWAY
WHITE PLAINS MD
20695-1050
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-6928
  • Fax: 301-609-6939
Mailing address:
  • Phone: 301-609-6928
  • Fax: 301-609-6939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number9591
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number9634
License Number StateMD

VIII. Authorized Official

Name: DR. SUZAN LOWRY
Title or Position: HEALTH OFFICER
Credential: MD
Phone: 301-609-2535