Basic Information
| Provider Information | |||||||||
| NPI: | 1851533632 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRINCE GEORGE HOSPITAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12406 THORNGATE LN | ||||||||
| Address2: | |||||||||
| City: | BOYDS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208414104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016376596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CHEVERLY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207851189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016183776 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2009 | ||||||||
| LastUpdateDate: | 03/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | VALENTI | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3016183772 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD, PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.