MEDICARE: PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
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10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
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15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
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17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023091915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	1701 MCCORMICK DR
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5329
Country	:	US
Telephone Number	:	301-883-7819
Fax Number	:	301-883-7890

Provider Business Practice Location Address
First Line	:	1701 MCCORMICK DR
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5329
Country	:	US
Telephone Number	:	301-883-7819
Fax Number	:	301-883-7890

Authorized Official
Title or Position	:	HEALTH OFFICER
Name	:	GWENDOLYN CLERKLY
Credential	:
Telephone Number	:	301-883-7819

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	03/01/2018

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MEDICARE: PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

Scope of Practice

Other Identifiers

General Provider Information

Similar Medicare Providers

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