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General NPI Number Information
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NPI Number | 1194976035
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Entity Type | Organization
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Legal Business Name | PRINCE GEORGE HOSPITAL CENTER
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 3001 HOSPITAL DR
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City | CHEVERLY
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State | MD
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Zip | 20785-1189
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Country | US
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Telephone | 301-618-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 HOSPITAL DR
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City | CHEVERLY
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State | MD
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Zip | 20785-1189
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Country | US
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Telephone | 301-618-2000
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | CHRISTEN LEDDER
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Credential | PA-C
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Telephone | 301-618-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | C003872
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License Number State | MD
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