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General NPI Number Information
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NPI Number | 1609673649
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Entity Type | Organization
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Legal Business Name | MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 28030 OLD VILLAGE ROAD
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City | MECHANICSVILLE
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State | MD
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Zip | 20659-3295
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Country | US
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Telephone | 301-884-4666
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Fax | 301-884-5852
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Provider Business Mailing Address
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Address Line | 24035 THREE NOTCH RD
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City | HOLLYWOOD
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State | MD
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Zip | 20636-4871
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Country | US
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Telephone | 301-373-7900
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Fax | 301-373-6900
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Authorized Official
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Title or Position | C.O.O.
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Name | ALAN ADAIR BUSTER
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Credential |
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Telephone | 301-373-7905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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