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Organization
PROVIDENCE HEALTH SERVICES
Active
Organization
PROVIDENCE HEALTH SERVICES
Active
Parent organization
PROVIDENCE HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HOSPITAL
Authorized official
TIMOTHY SHERIDAN (ASSISTANT VP, PRACTICE MGT SERVICES)
(202) 269-7374
Entity
Organization
Contact information
Practice address
4151 BLADENSBURG RD, COLMAR MANOR, MD 20722-1928
(301) 699-7700
(301) 779-9001
Mailing address
1150 VARNUM ST NE, WASHINGTON, DC 20017-2149
(202) 269-7286
(202) 269-7825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
HFD01-0212
DC
207R00000X
Internal Medicine Physician
HFD01-0212
DC
Other
Enumeration date
06/10/2008
Last updated
10/09/2017
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