Organization
SOUTHERN MARYLAND ORTHOPAEDIC & SPORTS MEDICI NE CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI MATTINGLY CMPE (PRACTICE ADMINISTRATOR)
(301) 475-5555
Entity
Organization
Contact information
Practice address
23000 MOAKLEY ST, SUITE 102, LEONARDTOWN, MD 20650-2915
(301) 475-5555
(301) 475-8535
Mailing address
23000 MOAKLEY ST, SUITE 102, LEONARDTOWN, MD 20650-2915
(301) 475-5555
(301) 475-8535
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225731900
—
MD
01
—
2878
BCBS
MD
Enumeration date
03/22/2007
Last updated
02/09/2009
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