Organization
MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC R WAGNER (EXECUTIVE VICE PRESIDENT)
(410) 772-6595
Entity
Organization
Contact information
Practice address
10 ST. PATRICK'S DRIVE, WALDORF, MD 20603-4527
(301) 373-7900
(301) 373-6900
Mailing address
24035 THREE NOTCH RD, HOLLYWOOD, MD 20636-4871
(301) 373-7900
(301) 373-6900
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1234
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80071330
—
MD
Enumeration date
02/23/2015
Last updated
08/04/2025
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