MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC (NPI# 1992057483) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992057483 |
| Entity Type | Organization |
| Organization Name | MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC |
| Practice Address |
7503 Surratts Rd Clinton MD 20735-3358 |
| Practice Telephone | 3018688000 |
| Mailing Telephone | 3018688000 |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2012-12-03 |
| Authorized Official Name | DEBORA KUCHKA-CRAIG (CORPORATE VICE PRESIDENT) |
| Authorized Official Telephone | 4107726827 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
| N | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| 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 |
| 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 |
| Street Address |
7503 SURRATTS RD |
| City | CLINTON |
| State | MD |
| Zip Code | 20735-3358 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881695807 | Southern Maryland Intensive Care, Inc. | Specialist | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2005-08-02 |
| 1154937829 | Medstar Medical Group II LLC | Health Educator | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2020-09-18 |
| 1720693732 | Kudi S Njembu | Nurse Practitioner | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2020-09-15 |
| 1831716760 | Chantal Tuell | Health Educator | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2020-06-26 |
| 1164049029 | Susan Jane Hicks | Health Educator | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2020-06-26 |
| 1790311009 | Mariam Yaktieen | Physician Assistant | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2020-03-18 |
| 1518592559 | Dana Hinesly | Physician Assistant | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2020-03-10 |
| 1528606845 | Chigozie Ndugba | Registered Nurse | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2019-12-17 |
| 1336784222 | Iris Chung | Physician Assistant | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2019-11-14 |
| 1740787191 | Faramade O Eruanga | Family Medicine | 7503 Surratts Rd, Clinton, MD 20735-3358 | 2018-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760940456 | Elise Olson | Occupational Therapist | 9135 Piscataway Rd, Suite 305, Clinton, MD 20735 | 2019-03-12 |
| 1437651742 | Total You Integrative Healthcare Inc | Clinic/Center | 9135 Piscataway Rd Ste 410, Clinton, MD 20735 | 2018-03-02 |
| 1386193233 | Benedicta C Osamor | Home Health Aide | 6808 Purple Lilac Ln, Clinton, MD 20735 | 2016-10-03 |
| 1669926309 | Frankline Ngozi Obi I | Home Health Aide | 8111 Highland Meadows Dr, Clinton, MD 20735 | 2016-08-11 |
| 1770952459 | Adventures One, Inc. | Clinic/Center | 7121 Old Alexandria Ferry Rd., Clinton, MD 20735 | 2015-09-23 |
| 1730574831 | Lindsey Degeorge | Emergency Medicine | 7503 Surratts Rd Dept Of, Clinton, MD 20735 | 2015-04-06 |
| 1316341860 | Margaret Laurence-whitlock | Speech-Language Pathologist | 5807 Terence Dr., Laurence Learning Center, Clinton, MD 20735 | 2014-10-13 |
| 1699103622 | Dcps | Social Worker | 5504 Trout Run Rd, Clinton, MD 20735 | 2013-10-30 |
| 1902232614 | Rafael Antonio Acosta | Dentist | 7905 Malcolm Rd Ste 300, Clinton, MD 20735 | 2013-09-25 |
| 1407135874 | Richelle Wilson Harvey | Occupational Therapist | 8202 Shackelford Way, Clinton, MD 20735 | 2011-08-16 |
| Find all providers in zip 20735 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
| 1245742808 | Field & Forest Medical, LLC | General Practice | 18565 S Bandy Ln, Clinton, IN 47842-7334 | 2017-11-03 |
| 1144692393 | Complete Wellness and Integrative Health Center Ltd | General Practice | 211 E Quincy St, Clinton, IL 61727 | 2015-10-28 |
| 1154561389 | Altmed Medical Center Inc | General Practice | 8700 Old Branch Ave, Clinton, MD 20735-2522 | 2009-02-27 |
| 1316149727 | Martin A Schiefer | General Practice | 100 Cedar Cove Turtle Creek, Clinton, MS 39056-5428 | 2007-06-05 |
| 1790733855 | Agapito Fajardo | General Practice | 906 N Us 421 Hwy, Clinton, NC 28328-0410 | 2006-05-04 |
| 1851363535 | Vincent S Toussaint | General Practice | 103 Mississippi Drive, Clinton, SC 29325 | 2006-02-06 |
| 1235118837 | Betty A Hibler | General Practice | 1320 Main Ave, Clinton, IA 52732-1923 | 2006-01-11 |
| 1457347379 | Roger E Jones | General Practice | 819 S 3rd St, Clinton, IN 47842-2205 | 2005-09-26 |
| 1073041299 | Russell Wayne Jefferson | General Practice | 501 S 11th St, Clinton, OK 73601-4303 | 2017-06-01 |
| 1710365382 | Mary Annette Pugh Md, Pllc | General Practice | 2500 Highway 65 S, Clinton, AR 72031-6588 | 2015-05-14 |
| Find all providers in CLINTON | ||||
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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.