Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Phs Family Medicine Glenn Dale

Organization Family Medicine Physician · NPI 1962842401

Phs Family Medicine Glenn Dale is a Family Medicine Physician in Glenn Dale, Maryland. Licensed in District of Columbia. Registered with an NPI since 2013.

Licensed in
DC
In the registry since
2013
Specialties on file
2

Practice location Address checks out

12200 Annapolis Rd Ste 118
Glenn Dale, MD 20769-9182
Phone: (301) 464-9300
Fax: (202) 854-4093
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence HFD01-0212 (DC)
General Acute Care Hospital Taxonomy 282N00000X · Licence HFD01-0212 (DC)

Record details

NPI number1962842401
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Hospital
Authorized official Charles Haberkern — Vp · (202) 854-4255
Other names Providence Health Services, Inc
NPI enumeratedJune 28, 2013
Last updated in NPPESSeptember 6, 2016
Mailing address1160 Varnum St Ne, St Catherine'S Hall, Room 102, Washington, DC 20017-2107

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