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NPI Code Detail

MEDICARE: PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT

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
1174H00000XHealth Educator

General Provider Information

NPI Number : 1477435634
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 : 6350 FREDERICK RD
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-2375
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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Directions to “PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT ” Practice Location

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