| Southern Maryland Primary Care, Llc | |
|
3460 Old Washington Rd Suite 203a Waldorf MD 20602-3240 | |
| (301) 638-9670 | |
| (301) 638-7558 |
| Full Name | Southern Maryland Primary Care, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3460 Old Washington Rd, Waldorf, Maryland |
| Authorized Official Name and Position | Niran P Sharma (OWNER) |
| Authorized Official Contact | 3016389670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Maryland Primary Care, Llc Po Box 1558 Waldorf MD 20604-1558 Ph: (301) 638-9670 | Southern Maryland Primary Care, Llc 3460 Old Washington Rd Suite 203a Waldorf MD 20602-3240 Ph: (301) 638-9670 |
| NPI Number | 1831386630 |
|---|---|
| Provider Enumeration Date | 09/26/2007 |
| Last Update Date | 12/18/2012 |
| Medicare PECOS PAC ID | 9335321694 |
|---|---|
| Medicare Enrollment ID | O20110308000125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831386630 | NPI | - | NPPES |
| 431203100 | Medicaid | MD | |
| F247 | Other | DC | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D78727 (Maryland) | Primary |
| Provider Name | Collins P Sein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699769554 PECOS PAC ID: 2769678002 Enrollment ID: I20101129000224 |
| Provider Name | Tammy Lanette Fusilier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366096034 PECOS PAC ID: 9931539517 Enrollment ID: I20200422001706 |
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