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

General Provider Information

NPI Number	:	1376861377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	3003 HOSPITAL DR
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1194
Country	:	US
Telephone Number	:	301-583-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 HOSPITAL DR
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1194
Country	:	US
Telephone Number	:	301-583-3700
Fax Number	:

Authorized Official
Title or Position	:	MANAGER, CLIENT INFORMATION SERVICE
Name	:	MRS. DARLENE WHITAKER
Credential	:
Telephone Number	:	301-883-7861

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	05/14/2010

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Directions to “PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT ” Practice Location

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