MEDSTAR MEDICAL GROUP-SOUTHERN MARYLAND, LLC (NPI# 1831592211) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831592211 |
| Entity Type | Organization |
| Organization Name | MEDSTAR MEDICAL GROUP-SOUTHERN MARYLAND, LLC |
| Practice Address |
24035 Three Notch Rd Hollywood MD 20636-4871 |
| Mailing Address |
Po Box 640 Hollywood MD 20636-0640 |
| Practice Telephone | 3013737900 |
| Practice Fax Number | 3013736900 |
| Mailing Telephone | 3013737900 |
| Mailing Fax Number | 3013736900 |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-09-30 |
| Authorized Official Name | ERIC R WAGNER (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Telephone | 4107726595 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
24035 THREE NOTCH RD |
| City | HOLLYWOOD |
| State | MD |
| Zip Code | 20636-4871 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154324440 | Nrh-cpt Regional Rehab LLC | Clinic/Center | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2005-05-31 |
| 1013537943 | Sydney Deems | Student in an Organized Health Care Education/Training Program | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2020-04-21 |
| 1477182293 | Jewel Lucendia Ory | Dietitian, Registered | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2020-04-03 |
| 1447887781 | National Rehabiliation Hospital, Inc | Clinic/Center | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2020-03-25 |
| 1083252613 | Crystal Martirano | Physical Therapy Assistant | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2019-12-13 |
| 1447894597 | Neelesh Katkar | Physical Therapist | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2019-11-01 |
| 1497398093 | Rachel Leanne Bilo | Physician Assistant | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2019-10-26 |
| 1467015560 | Dawn Marie Drury | Nurse Practitioner | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2019-04-15 |
| 1194249177 | Mary Clark Magill | Registered Nurse | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2017-08-01 |
| 1750802005 | Yazan Yacoub Hanna Sawalha | Student in an Organized Health Care Education/Training Program | 24035 Three Notch Rd, Hollywood, MD 20636-4871 | 2017-06-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841708427 | Lisa Early | Case Manager/Care Coordinator | 24077 John Cameron Way, Hollywood, MD 20636 | 2018-01-17 |
| 1326439365 | Maryland Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 24288 Three Notch Rd., Hollywood, MD 20636 | 2015-02-12 |
| 1972810612 | Kathleen Latona Boyles | Pharmacist | 24288 Three Notch Road, Hollywood, MD 20636 | 2010-09-01 |
| 1386825271 | Vijaya Guduri | Internal Medicine | 24035 Three Notch Road, Shah Associates Md LLC, Hollywood, MD 20636 | 2007-11-19 |
| 1245397678 | St Johns Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 24288 Three Notch Rd, Hollywood, MD 20636 | 2007-01-03 |
| 1194824755 | Julie Wilkening | Chiropractor | 24351 Mervell Dean Rd #115, Hollywood, MD 20636 | 2006-09-21 |
| 1225134281 | Mary Rice Hughes | Registered Nurse | 44101 Airport View Dr., Hollywood, MD 20636 | 2006-09-16 |
| 1376654194 | Suzanne Janis Pelz | Counselor | 44101 Airport View Drive, Hollywood, MD 20636 | 2006-08-31 |
| 1750549010 | Iram A Khan | Internal Medicine | 24035 Three Notch Road, Hollywood, MD 20636 | 2008-05-22 |
| 1851473110 | John Elliott Walker | Registered Nurse | 44101 Airport View Drive, Hollywood, MD 20636 | 2006-10-19 |
| Find all providers in zip 20636 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629694203 | Oaks Medical Group, LLC | Internal Medicine | 2854 Jackson St, Hollywood, FL 33020 | 2020-06-19 |
| 1699265363 | Primary Care Physicians of Hollywood, Pl | Internal Medicine | 3700 Washington St Ste 203, Hollywood, FL 33021-8249 | 2018-05-17 |
| 1174048433 | Robert Terry Smith | Internal Medicine | 1530 Seagrape Way, Hollywood, FL 33019-4862 | 2017-08-08 |
| 1528425204 | Jody Ritter | Internal Medicine | 3700 Washington St Ste 500a, Hollywood, FL 33021-8256 | 2016-01-26 |
| 1639534787 | Renovo Medical Consulting | Internal Medicine | 4770 Stono Links Dr, Hollywood, SC 29449-5984 | 2015-12-16 |
| 1669849741 | Anay Puntonet | Internal Medicine | 3700 Washington St Ste 305, Hollywood, FL 33021-8249 | 2015-08-25 |
| 1861898843 | Metamorphosis Medispa & Wellness Center | Internal Medicine | 2104 Tyler St, Hollywood, FL 33020-6717 | 2014-11-18 |
| 1053720243 | Foundation for Sickle Cell Disease Research | Internal Medicine | 3858 Sheridan St Ste S, Hollywood, FL 33021-3625 | 2014-08-12 |
| 1487096210 | Murray Neil Cohen | Internal Medicine | 2820 Fairway Dr, Hollywood, FL 33021-2937 | 2013-07-22 |
| 1942555107 | Luis M Gonzalez Sr. | Internal Medicine | 1200 S Federal Hway, Lux Medical Health Center, Hollywood, FL 33020 | 2012-07-13 |
| Find all providers in HOLLYWOOD | ||||
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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.