# MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720322134
- **Authorized official:** DEBORA KUCHKA-CRAIG (CORPORATE VICE PRESIDENT)
- **Authorized official phone:** (410) 772-6827

## Contact information

- **Practice address:** 10 SAINT PATRICKS DR, SUITE 203, WALDORF, MD 20603-4527
- **Practice address phone:** (301) 843-0222
- **Practice address fax:** (301) 843-0651
- **Mailing address:** 10 SAINT PATRICKS DR, SUITE 203, WALDORF, MD 20603-4527
- **Mailing address phone:** (301) 843-0222
- **Mailing address fax:** (301) 843-0651

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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