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PROVIDENCE HEALTH SERVICES
NPI 1487922803
Surgery in Glenn Dale, MD

Active since December 13, 2011
12200 ANNAPOLIS RD, SUITE 123, GLENN DALE, MD 20769(202) 448-4014(202) 372-0029 Get Directions Write a Review

NPPES record last updated: October 9, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Providence Health Services NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE HEALTH SERVICES (NPI 1487922803) is a healthcare organization registered as a surgery in Glenn Dale, Maryland and active in the NPI registry since December 2011. The organization lists Beau Higginbotham, Vice President/coo, as its authorized official.

NPPES Registry Identity

NPI1487922803
Entity TypeOrganization
Primary Taxonomy208600000X
Legal Business NamePHS GLENN DALE
Location Address12200 ANNAPOLIS RD, SUITE 123Glenn Dale, MD 20769-9182
Mailing Address1160 Varnum St Ne, St Catherine's Hall, Room 102Washington, DC 20017-2107 · (202) 854-4069 · Fax (202) 854-7825
Phone(202) 448-4014
Fax(202) 372-0029
Organization SubpartYesParent: Providence Hospital
Authorized OfficialBeau HigginbothamVice President/coo · (410) 368-3162
Enumeration DateDecember 13, 2011
Last NPPES UpdateOctober 9, 2017
✔ NPI 1487922803 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in DC · HFD01-0212
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Also ListedGeneral Acute Care HospitalTaxonomy 282N00000X · License HFD01-0212 (DC)
12200 ANNAPOLIS RD, Glenn Dale, MD 20769
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Other Names 1

Other NameProvidence Health Services

Other Identifiers 4

Medicaid09810714VA
Medicaid029833400DC
Medicaid005145400MD
Medicare PIN090006

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARYLAND SPECIALTY GROUP LLC
Obstetrics & Gynecology
12200 ANNAPOLIS RD, SUITE# 123
GLENN DALE, MD 20769
Prince George's County (301) 552-9495
MARTHA JOHNSON
Massage Therapist
12200 ANNAPOLIS RD, SUITE 221
GLENN DALE, MD 20769
Prince George's County (301) 352-2991
WHOLISTIC RESTORATIONS LLC
Clinic/Center (Adult Mental Health)
12200 ANNAPOLIS RD, SUITE 320
GLENN DALE, MD 20769
Prince George's County (301) 399-9119
MARYLAND SPECIALTY GROUP LLC
Surgery (Vascular Surgery)
12200 ANNAPOLIS RD, STE 123
GLENN DALE, MD 20769
Prince George's County (301) 552-9495
ADVANCED EYE CARE MEDICAL CENTER
Ophthalmology
12200 ANNAPOLIS RD, SUITE 116
GLENN DALE, MD 20769
Prince George's County (301) 805-4664
LARRY W. BRYANT DDS, PC
Dentist (Oral and Maxillofacial Surgery)
12200 ANNAPOLIS RD, SUITE 236-240
GLENN DALE, MD 20769
Prince George's County (301) 249-0553
DR. VALERIE DAWN CALLENDER M.D.
Dermatology
12200 ANNAPOLIS RD, SUITE 315
GLENN DALE, MD 20769
Prince George's County (301) 249-0970
NICOLE C LAWSON OT
Occupational Therapist
12200 ANNAPOLIS RD, SUITE 225
GLENN DALE, MD 20769
Prince George's County (301) 860-0003

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Phs Glenn Dale's NPI number?

The NPI number for Phs Glenn Dale is 1487922803. It was assigned to this organization in the NPPES registry on December 13, 2011. The provider is also known as Providence Health Services.

Where is Phs Glenn Dale located?

Phs Glenn Dale is located at 12200 Annapolis Rd Suite 123, Glenn Dale, MD 20769. The listed phone number is (202) 448-4014.

What is Phs Glenn Dale's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

When was this NPI record last updated?

The NPPES record for Phs Glenn Dale was last updated on October 9, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.