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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1427930684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	1701 MCCORMICK DR STE 120
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5329
Country	:	US
Telephone Number	:	240-302-8576
Fax Number	:

Provider Business Practice Location Address
First Line	:	4390 PARLIAMENT PL STE A
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-1866
Country	:	US
Telephone Number	:	301-883-7879
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	TAMALA VICKS
Credential	:
Telephone Number	:	240-302-8576

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	12/16/2025

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