Organization
OLD BRANCH HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRIE L BALLENGER (ADMINISTRATOR)
(301) 899-5140
Entity
Organization
Contact information
Practice address
4333 OLD BRANCH AVE, TEMPLE HILLS, MD 20748-1848
(301) 899-5140
(301) 899-5153
Mailing address
PO BOX 6396, LARGO, MD 20792-6396
(301) 899-5140
(301) 899-5153
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
D0054991
MD
207R00000X
Internal Medicine Physician
D0019935
MD
207R00000X
Internal Medicine Physician
D0046312
MD
208000000X
Pediatrics Physician
Primary
DD36306
MD
Other
Enumeration date
06/02/2011
Last updated
06/02/2011
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