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NPI Code Detail

MEDICARE: MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC

MEDICARE: MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC
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
1261QA1903XAmbulatory Surgical Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891626594
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC
Provider Business Mailing Address
First Line : 24035 THREE NOTCH RD
Second Line :
City : HOLLYWOOD
State : MD
Zip : 20636-4871
Country : US
Telephone Number : 301-373-7900
Fax Number : 301-373-6900
Provider Business Practice Location Address
First Line : 130 HOSPITAL DRIVE
Second Line : STE 300
City : PRINCE FREDERICK
State : MD
Zip : 20678-4057
Country : US
Telephone Number : 301-373-7900
Fax Number : 301-373-6900
Authorized Official
Title or Position : C.O.O.
Name : ALAN ADAIR BUSTER JR.
Credential :
Telephone Number : 301-373-7905
Provider Enumeration Date : 05/29/2026
Last Update Date : 05/29/2026

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Directions to “MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC ” Practice Location

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