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Organization
MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Active
Organization
MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORA KUCHKA-CRAIG (CORPORATE VICE PRESIDENT)
(410) 772-6827
Entity
Organization
Contact information
Practice address
10 SAINT PATRICKS DR, SUITE 203, WALDORF, MD 20603-4527
(301) 843-0222
(301) 843-0651
Mailing address
10 SAINT PATRICKS DR, SUITE 203, WALDORF, MD 20603-4527
(301) 843-0222
(301) 843-0651
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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