PROVIDENCE HEALTH SERVICES, INC
NPI 1962842401
Family Medicine in Glenn Dale, MD

Q: What is Phs Family Medicine Glenn Dale's NPI number?

The NPI number for Phs Family Medicine Glenn Dale is 1962842401. It was assigned to this organization in the NPPES registry on June 28, 2013. The provider is also known as Providence Health Services, Inc.

Q: What is Phs Family Medicine Glenn Dale's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since June 28, 2013

12200 ANNAPOLIS RD, SUITE 118, GLENN DALE, MD 20769(301) 464-9300(202) 854-4093 Get Directions Write a Review

NPPES record last updated: September 6, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Providence Health Services, Inc NPPES

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

PROVIDENCE HEALTH SERVICES, INC (NPI 1962842401) is a healthcare organization registered as a family medicine in Glenn Dale, Maryland and active in the NPI registry since June 2013. The organization lists Charles F Haberkern, Vp, as its authorized official.

NPPES Registry Identity

NPI1962842401

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NamePHS FAMILY MEDICINE GLENN DALE

Location Address12200 ANNAPOLIS RD, SUITE 118Glenn 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(301) 464-9300

Fax(202) 854-4093

Organization SubpartYesParent: Providence Hospital

Authorized OfficialCharles F HaberkernVp · (202) 854-4255

Enumeration DateJune 28, 2013

Last NPPES UpdateSeptember 6, 2016

✔ NPI 1962842401 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in DC · HFD01-0212

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

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, Inc

Other Identifiers 4

Medicare PIN090006DC

Medicaid029833400DC

Medicaid09810714VA

Medicaid005145400MD

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 Family Medicine Glenn Dale's NPI number?

The NPI number for Phs Family Medicine Glenn Dale is 1962842401. It was assigned to this organization in the NPPES registry on June 28, 2013. The provider is also known as Providence Health Services, Inc.

Where is Phs Family Medicine Glenn Dale located?

Phs Family Medicine Glenn Dale is located at 12200 Annapolis Rd Suite 118, Glenn Dale, MD 20769. The listed phone number is (301) 464-9300.

What is Phs Family Medicine Glenn Dale's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Phs Family Medicine Glenn Dale was last updated on September 6, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.