MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC (NPI# 1780629683) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780629683 |
| Entity Type | Organization |
| Organization Name | MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC |
| Other Organization Name | WALDORF FAMILY MEDICAL CENTER |
| Practice Address |
10 St Patricks Drive Suite 203 Waldorf MD 20603-4527 |
| Mailing Address |
10403 Hospital Drive Suite G-4 Clinton MD 20735-3134 |
| Practice Telephone | 3018430222 |
| Practice Fax Number | 3018430651 |
| 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 |
|---|---|
| Waldorf 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 |
| 1427093343 | Medstar Southern Maryland Physicians, LLC | Family Medicine | 6409 South Crain Highway, Route 301, Upper Marlboro, MD 20772 | 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 |
10 ST PATRICKS DRIVE SUITE 203 |
| City | WALDORF |
| State | MD |
| Zip Code | 20603-4527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764214 | Kelly Weaver | Nurse Practitioner | 11315 Pembroke Square, 110, Waldorf, MD 20603 | 2020-09-09 |
| 1962937839 | Alexis Nicole Smith | Specialist/Technologist | 6115 Tapir Pl, Waldorf, MD 20603 | 2017-04-27 |
| 1235585472 | Msb Counseling Services, Inc | Counselor | 1282 Smallwood Drive W, Suite 460, Waldorf, MD 20603 | 2016-05-06 |
| 1619390325 | Tara Wood | Nurse Practitioner | 3070crain Highway, Waldorf, MD 20603 | 2014-01-31 |
| 1649603424 | Lauren Ashley White | Speech-Language Pathologist | 10810 Winchester Street Apt127, Waldorf, MD 20603 | 2013-08-15 |
| 1477810067 | Johnathan Vital | Clinical Neuropsychologist | 2413 Altenburg Ct, Waldorf, MD 20603 | 2012-04-19 |
| 1831480615 | Tara Marie Adams | Physical Therapist | 11340 Pembrooke Sq Ste 211, Waldorf, MD 20603 | 2011-04-27 |
| 1891007662 | Tanuja Katta | Pharmacist | 3385 Crain High Way, Rite Aid 11197, Waldorf, MD 20603 | 2010-07-09 |
| 1962725697 | Rhonda Bumpers-bland | Occupational Therapist | 2945 Fern Hill Place, Waldorf, MD 20603 | 2010-03-09 |
| 1265672901 | Shannon L Hamm | Counselor | 6126 Gray Wolf Court, Waldorf, MD 20603 | 2009-02-20 |
| Find all providers in zip 20603 | ||||
| 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 |
|---|---|---|---|---|
| 1801452362 | Outreach Recovery II, LLC | Family Medicine | 3649 Leonardtown Rd, Waldorf, MD 20601-3626 | 2019-05-10 |
| 1154764744 | Ashley Dunn-kerr | Family Medicine | 3225 Crain Hwy, Waldorf, MD 20603-4848 | 2013-04-12 |
| 1952564973 | Majd M Arnaout | Family Medicine | 177 Saint Patricks Drive, Waldorf, MD 20603-5533 | 2008-07-09 |
| 1841452687 | Lulita Lucero-ugalino | Family Medicine | 6b Industrial Park Drive, Unit 8, Waldorf, MD 20735-2073 | 2008-07-01 |
| 1194765834 | Dainty J Jackson | Family Medicine | 11315 Pembrooke Sq Ste 112, Waldorf, MD 20603-4806 | 2006-06-08 |
| 1831177419 | Michael P. Dalgetty | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2006-01-04 |
| 1679579361 | Richard A Farson | Family Medicine | 10 Saint Patricks Dr, Ste 203, Waldorf, MD 20603-4527 | 2005-06-27 |
| 1508341009 | Prime Medical Health Center, Inc | Family Medicine | 6b Industrial Park Drive, Unit 8, Waldorf, MD 20735-2073 | 2018-10-01 |
| 1194104729 | Lachrisa S. Jennings | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2015-05-28 |
| 1578957932 | Ganiyat Olasumbo Anike Oladapo | Family Medicine | 2855 Crain Hwy, Waldorf, MD 20601-2840 | 2015-03-24 |
| Find all providers in WALDORF | ||||
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| 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.