Prince George's County Health Department

Organization Adolescent Medicine (Family Medicine) Physician · NPI 1194213728

Prince George's County Health Department is an Adolescent Medicine (Family Medicine) Physician in Bladensburg, Maryland. Registered with an NPI since 2018.

In the registry since: 2018
Specialties on file: 2

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Practice location Address checks out

4200 57th Ave
Bladensburg, MD 20710-1710
Phone: (240) 696-3356
Fax: (301) 883-7890

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

Specialties & licences

Student Health Clinic/Center (primary)	Taxonomy 261QS1000X
Adolescent Medicine (Family Medicine) Physician	Taxonomy 207QA0000X

Record details

NPI number	1194213728
Entity type	Organization (Type 2)
Organization subpart	Yes
Parent organization	Prince George's County Health Department
Authorized official	Tamala Butler — Credentialing Specialist · (301) 883-7822
Other names	Prince George'S County Health Department-Sbw-Bladensburg
NPI enumerated	April 30, 2018
Last updated in NPPES	September 17, 2020
Certification date	September 17, 2020
Mailing address	1701 McCormick Dr Ste 120, Largo, MD 20774-5329