MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC (NPI# 1427093343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427093343 |
| Entity Type | Organization |
| Organization Name | MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC |
| Other Organization Name | UPPER MARLBORO FAMILY MEDICAL CENTER |
| Practice Address |
6409 South Crain Highway Route 301 Upper Marlboro MD 20772 |
| Mailing Address |
10403 Hospital Drive Suite G-4 Clinton MD 20735-3134 |
| Practice Telephone | 3019528614 |
| Practice Fax Number | 3019529030 |
| Mailing Telephone | 3018563019 |
| Mailing Fax Number | 3018569370 |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2013-03-15 |
| Authorized Official Name | JANE RAYMOND (VICE PRESIDENT) |
| Authorized Official Telephone | 3018563019 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Upper Marlboro Family Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982753877 | Medstar Southern Maryland Physicians, LLC | Pediatrics | 10 Saint Patricks Drive, Suite 105, Waldorf, MD 20603-4519 | 2007-01-09 |
| 1780629683 | Medstar Southern Maryland Physicians, LLC | Family Medicine | 10 St Patricks Drive, Suite 203, Waldorf, MD 20603-4527 | 2006-06-17 |
| 1174568091 | Medstar Southern Maryland Physicians, LLC | Family Medicine | 900 East Swan Creek Road, Fort Washington, MD 20744 | 2006-06-17 |
| 1801837786 | Medstar Southern Maryland Physicians, LLC | Internal Medicine | 10403 Hospital Drive, Suite 103, Clinton, MD 20735-3134 | 2006-06-09 |
| 1063880599 | Medstar Southern Maryland Physicians, LLC | Surgery | 7501 Surratts Rd, Suite 208, Clinton, MD 20735-3362 | 2015-09-15 |
| 1316340201 | Medstar Southern Maryland Physicians, LLC | Obstetrics & Gynecology | 11340 Pembrooke Sq, Suite 203, Waldorf, MD 20603-4808 | 2014-10-06 |
| 1871903054 | Medstar Southern Maryland Physicians, LLC | Surgery | 7501 Surratts Rd, Suite 305, Clinton, MD 20735-3362 | 2014-04-28 |
| 1720322134 | Medstar Southern Maryland Physicians, LLC | Internal Medicine | 10 Saint Patricks Dr, Suite 203, Waldorf, MD 20603-4527 | 2012-11-26 |
| 1184977142 | Medstar Southern Maryland Physicians, LLC | Anesthesiology | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2012-10-16 |
| 1992057483 | Medstar Southern Maryland Physicians, LLC | Anesthesiology | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2012-10-08 |
| Street Address |
6409 SOUTH CRAIN HIGHWAY ROUTE 301 |
| City | UPPER MARLBORO |
| State | MD |
| Zip Code | 20772 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355077 | Doris Lynn Perkins | Pharmacist | 5700 Southeast Crain Hwy, Upper Marlboro, MD 20772 | 2020-10-31 |
| 1730790221 | Creative Mind Therapy | Community/Behavioral Health | 12419 Dorsey Ln, Upper Marlboro, MD 20772 | 2020-08-10 |
| 1932727369 | Shaquitta Morton | Behavior Technician | 9440 Marlboro Pike 100, Upper Marlboro, MD 20772 | 2020-07-13 |
| 1760022958 | Keri Daniel | Nurse Practitioner | 9723 Frank Tippett Rd, Upper Marlboro, MD 20772 | 2020-01-15 |
| 1932668134 | Dentistry for Children of Maryland, LLC | Clinic/Center | 9616 Marlboro Pike, Upper Marlboro, MD 20772 | 2019-03-18 |
| 1033673918 | Shonte Renee Drakeford | Nurse Practitioner | 6610 Woodyard Road, Upper Marlboro, MD 20772 | 2019-01-25 |
| 1902391261 | Myenne Hanson | Home Health Aide | 5002 Ashford Dr, Upper Marlboro, MD 20772 | 2018-06-28 |
| 1659884849 | Clement Okehie | Home Health Aide | 13939 Bishops Bequest Rd, Upper Marlboro, MD 20772 | 2017-11-09 |
| 1497264766 | Fatu Barrie | Technician | 11112 Cranfod Drive, Upper Marlboro, MD 20772 | 2017-09-29 |
| 1801315080 | Hope Academy & Nursing Services | Nursing Care | 14101 Christian Street, Upper Marlboro, MD 20772 | 2017-09-19 |
| Find all providers in zip 20772 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134598055 | Ayah Mumah Taniform | Family Medicine | 10600 Melwood Chapel Ln, Upper Marlboro, MD 20772-2960 | 2015-09-21 |
| 1306092135 | Anna Balkisue Mccall | Family Medicine | 3203 Valley Forest Dr, Upper Marlboro, MD 20772 | 2008-08-12 |
| 1144492471 | Tahani Laila Williams | Family Medicine | 14904 Van Wagner Rd, Upper Marlboro, MD 20772-9721 | 2008-03-26 |
| 1780728154 | Adora N Otiji | Family Medicine | 20 Watkins Park Dr, Upper Marlboro, MD 20774-1628 | 2007-02-17 |
| 1336280866 | Ben P Binghay | Family Medicine | 9654 Marlboro Pike, Upper Marlboro, MD 20772-3670 | 2007-02-09 |
| 1457462806 | John Herman Wills | Family Medicine | 14310 Old Marlboro Pike, Upper Marlboro, MD 20772-2840 | 2006-08-31 |
| 1619973534 | Arnulfo B Bonavente | Family Medicine | 6409 Crain Hwy, Route 301, Upper Marlboro, MD 20772-4139 | 2005-06-24 |
| 1215931779 | Alain Guy Champaloux | Family Medicine | 14314 Old Marlboro Pike, Upper Marlboro, MD 20772-2840 | 2005-06-10 |
| 1992153407 | Malori Monet Callender | Family Medicine | 1221 Mercantile Ln, Upper Marlboro, MD 20774-5374 | 2016-05-25 |
| 1992110191 | Aysha Khan | Family Medicine | 1221 Mercantile Ln, Upper Marlboro, MD 20774-5374 | 2014-06-25 |
| Find all providers in UPPER MARLBORO | ||||
| City | UPPER MARLBORO |
| Zip Code | 20772 |
Please comment or provide details below to improve the information on MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.