| Providence Health Services | |
|
4151 Bladensburg Rd Colmar Manor MD 20722-1928 | |
| (301) 699-7700 | |
| (301) 779-9001 |
| Full Name | Providence Health Services |
|---|---|
| Speciality | Family Medicine |
| Location | 4151 Bladensburg Rd, Colmar Manor, Maryland |
| Authorized Official Name and Position | Charles F Haberkern (VP) |
| Authorized Official Contact | 2028544255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health Services 1160 Varnum St Ne St Catherine's Hall, Room 102 Washington DC 20017-2107 Ph: (202) 854-4069 | Providence Health Services 4151 Bladensburg Rd Colmar Manor MD 20722-1928 Ph: (301) 699-7700 |
| NPI Number | 1184992794 |
|---|---|
| Provider Enumeration Date | 12/09/2011 |
| Last Update Date | 09/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184992794 | NPI | - | NPPES |
| 005145400 | Medicaid | MD | |
| 029833400 | Medicaid | DC | |
| 09810714 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | HFD01-0212 (District Of Columbia) | Primary |
| 282N00000X | General Acute Care Hospital | HFD01-0212 (District Of Columbia) | Secondary |
Providence Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4151 Bladensburg Rd, Colmar Manor, MD 20722 Phone: 301-699-7700 Fax: 301-779-9001 |