# CIVISTA CLINICAL SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CIVISTA CLINICAL SERVICES, LLC
- **Other names:** University of Maryland Charles Regional OB/GYN
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205035805
- **Legal business name:** CIVISTA CLINICAL SERVICES, LLC
- **Authorized official:** STEPHANIE SIMM (PHYSICIAN RELATIONS SPECIALISTS)
- **Authorized official phone:** (301) 609-4539

## Contact information

- **Practice address:** 605 EAST CHARLES STREET, LA PLATA, MD 20646
- **Practice address phone:** (301) 609-4800
- **Practice address fax:** (301) 609-5220
- **Mailing address:** 605 EAST CHARLES STREET, LA PLATA, MD 20646
- **Mailing address phone:** (301) 609-4800
- **Mailing address fax:** (301) 609-5220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2007
- **Last updated:** 05/15/2015