# MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WALDORF ENT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598060709
- **Authorized official:** JANE RAYMOND (VP)
- **Authorized official phone:** (301) 868-3019

## Contact information

- **Practice address:** 10 SAINT PATRICKS DR, SUITE 202, WALDORF, MD 20603-4527
- **Practice address phone:** (301) 396-8071
- **Practice address fax:** (301) 396-4671
- **Mailing address:** 10403 HOSPITAL DR, SUITE G4, CLINTON, MD 20735-3134
- **Mailing address phone:** (301) 868-3019
- **Mailing address fax:** (301) 856-9370

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | MD | Yes |

## Other

- **Enumeration date:** 01/19/2011
- **Last updated:** 03/15/2013