Organization · Type 2 NPI

Prince George's County Health Department

Student Health Clinic/Center · Bladensburg, MD

NPI number 1194213728 Active

Practice location

4200 57th Ave
Bladensburg, MD 20710-1710

Call (240) 696-3356 Map

Fax (301) 883-7890

Mailing address

1701 Mccormick Dr Ste 120
Largo, MD 20774-5329

Specialties and licenses

Taxonomy	Code	License
Adolescent Medicine (Family Medicine) Physician	207QA0000X	None listed
Student Health Clinic/Center Primary	261QS1000X	None listed

Student Health Clinic/Center: Definition to come...

NPI record

NPI: 1194213728
Entity type: Organization (Type 2)
Issued: Apr 30, 2018
Last updated: Sep 17, 2020
Status: Active
Subpart: Yes of Prince George's County Health Department

Other names

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Prince George's County Health Department-Sbw-Bladensburg · other name

Authorized official

Tamala Butler
Credentialing Specialist
(301) 883-7822

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1194213728

Prince George's County Health Department's National Provider Identifier is 1194213728, issued on Apr 30, 2018. The primary taxonomy on file is Student Health Clinic/Center (261QS1000X), and the practice location is in Bladensburg, MD. The record was last updated on Sep 17, 2020.