PRINCE GEORGES ENT HEAD & NECK SURGERY, LLC (NPI# 1992352033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992352033 |
| Entity Type | Organization |
| Organization Name | PRINCE GEORGES ENT HEAD & NECK SURGERY, LLC |
| Other Organization Name | PRINCE GEORGES ENT HEAD & NECK SURGERY |
| Practice Address |
10 Saint Patricks Dr Waldorf MD 20603-4527 |
| Mailing Address |
1100 Mercantile Ln Ste 136 Uppr Marlboro MD 20774-5367 |
| Practice Telephone | 3013737900 |
| Practice Fax Number | 3013736900 |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2020-11-06 |
| Authorized Official Name | DR. BRYAN CHINAEMEREM EGO-OSUALA (PRESIDENT) |
| Authorized Official Telephone | 2029998413 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Prince Georges ENT Head & Neck Surgery | Doing Business As Name - Organization |
| Street Address |
10 SAINT PATRICKS DR |
| City | WALDORF |
| State | MD |
| Zip Code | 20603-4527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679579361 | Richard A Farson | Family Medicine | 10 Saint Patricks Dr, Ste 203, Waldorf, MD 20603-4527 | 2005-06-27 |
| 1215545306 | Vpkt Shah Rx LLC | Pharmacy | 10 Saint Patricks Dr, Waldorf, MD 20603-4527 | 2020-07-15 |
| 1154877959 | Katelyn Schuster | Physical Therapist | 10 Saint Patricks Dr, Suite 401, Waldorf, MD 20603-4527 | 2016-08-31 |
| 1366819542 | Jacquelyn Church | Physical Therapist | 10 Saint Patricks Dr, Suite 401, Waldorf, MD 20603-4527 | 2015-08-24 |
| 1487049292 | Najmeh Izadpanah | Anesthesiology | 10 Saint Patricks Dr, Waldorf, MD 20603-4527 | 2015-03-30 |
| 1013326495 | Christopher Todd Wogamon | Specialist/Technologist | 10 Saint Patricks Dr, Waldorf, MD 20603-4527 | 2014-08-11 |
| 1770919284 | Brian David Sawyer | Physical Therapist | 10 Saint Patricks Dr, Suite 401, Waldorf, MD 20603-4527 | 2013-09-17 |
| 1417381773 | Jillian Dean | Physical Therapist | 10 Saint Patricks Dr, Suite 401, Waldorf, MD 20603-4527 | 2013-08-22 |
| 1346673548 | Cynthia Cue | Nurse Practitioner | 10 Saint Patricks Dr, Suite 502, Waldorf, MD 20603-4527 | 2013-08-12 |
| 1780021444 | Ryerson Stinson | Occupational Therapist | 10 Saint Patricks Dr, Suite 401, Waldorf, MD 20603-4527 | 2013-06-04 |
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| 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 |
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| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689747735 | Gary Rogers Mason | Otolaryngology | 11355 Pembrooke Square, Suite 108, Waldorf, MD 20603 | 2006-11-16 |
| 1598060709 | Medstar Southern Maryland Physicians, LLC | Otolaryngology | 10 Saint Patricks Dr, Suite 202, Waldorf, MD 20603-4527 | 2011-01-19 |
| 1336321462 | Pembrooke Square Ent Associates, LLC | Otolaryngology | 11355 Pembrooke Sq Ste 108, Waldorf, MD 20603-4805 | 2007-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194219899 | Hearing and Balance Centers of The Chesapeake LLC | Otolaryngology | 4000 Mitchellville Rd Ste A410, Bowie, MD 20716-3141 | 2018-06-18 |
| 1023539632 | Ent Allergy and Asthma Center PC | Otolaryngology | 11119 Rockville Pike Ste 207, North Bethesda, MD 20852-3143 | 2017-07-05 |
| 1770945917 | Michelle S Hwang | Otolaryngology | 600 N Caroline St, 6th Floor, Baltimore, MD 21205-1839 | 2016-03-27 |
| 1962817098 | Sunny Joseph Haft | Otolaryngology | James T. Frenkil Bldg, 16 S Eutaw Street, Suite 500, Baltimore, MD 21201-9000 | 2014-06-27 |
| 1790195485 | Total Ent Care LLC | Otolaryngology | 3333 N Calvert St Ste 680, Baltimore, MD 21218-6517 | 2014-05-02 |
| 1700206869 | Joseph Choi Park | Otolaryngology | 601 N Caroline St # Street6, Baltimore, MD 21287-0006 | 2014-04-16 |
| 1689091522 | Omar Gasudraz Ahmed | Otolaryngology | 601 N Caroline St Ste 6011, Baltimore, MD 21287-0006 | 2014-03-27 |
| 1871936112 | Deepa J Galaiya | Otolaryngology | 601 N Caroline St Ste 6, Baltimore, MD 21287-0006 | 2013-04-16 |
| 1225392558 | Nicholas Ray Rowan | Otolaryngology | 601 N Caroline St Ste 6161, Baltimore, MD 21287-0006 | 2012-07-02 |
| 1598034183 | Edward John Drawbaugh | Otolaryngology | 19004 Cherry Tree Dr, Hagerstown, MD 21742-2633 | 2011-12-28 |
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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.