=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477350403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 12/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 HOSPITAL RD STE 300
-----------------------------------------------------
City | PRINCE FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20678-4057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-535-4333
-----------------------------------------------------
Fax | 410-535-0495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24035 THREE NOTCH RD
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20636-4871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-373-7900
-----------------------------------------------------
Fax | 301-373-6900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.O.O.
-----------------------------------------------------
Name | ALAN ADAIR BUSTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-373-7905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------