| 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 | Timothy Sheridan (ASSISTANT VP, PRACTICE MGT SERVICES) |
| Authorized Official Contact | 2022697374 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health Services 1150 Varnum St Ne Washington DC 20017-2149 Ph: (202) 269-7286 | Providence Health Services 4151 Bladensburg Rd Colmar Manor MD 20722-1928 Ph: (301) 699-7700 |
| NPI Number | 1194985515 |
|---|---|
| Provider Enumeration Date | 06/10/2008 |
| Last Update Date | 10/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194985515 | NPI | - | NPPES |
| 548521501 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | HFD01-0212 (District Of Columbia) | Primary |
| 207R00000X | Internal Medicine | 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 |