Phs Glenn Dale

NPI #1487922803 in Glenn Dale, Maryland

Provider Information

NPI Number
1487922803
Entity Type
Organization
Organization Name
Phs Glenn Dale
Subpart
Yes (part of a larger organization)
Parent Organization
PROVIDENCE HOSPITAL
Primary Specialty
Surgery
Enumeration Date
Dec 13, 2011
Last Updated
Oct 9, 2017

Practice Location

Address
12200 ANNAPOLIS RD
Address 2
SUITE 123
ZIP Code
20769-9182
Phone
(202) 448-4014

Authorized Official

Name
BEAU HIGGINBOTHAM
Title
VICE PRESIDENT/COO
Phone
(410) 368-3162

Specialties & Taxonomy Codes

Specialty
General Acute Care Hospital
Surgery

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