Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Phs Family Medicine Glenn Dale

Organization Family Medicine Physician · NPI 1962842401

Phs Family Medicine Glenn Dale provides Family Medicine Physician services in Glenn Dale, Maryland. Licensed in District of Columbia. Registered with an NPI since 2013.

Licensed in
DC
In the registry since
2013
Specialties on file
2
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Practice location Address checks out

12200 Annapolis Rd Ste 118
Glenn Dale, MD 20769-9182 Not confirmed with CMS for 10 years — call before visiting
Phone: (301) 464-9300
Fax: (202) 854-4093
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence HFD01-0212 (DC)
General Acute Care Hospital Taxonomy 282N00000X · Licence HFD01-0212 (DC)

Record details

NPI number1962842401
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Hospital
Authorized official Charles Haberkern — Vp · (202) 854-4255
Other names Providence Health Services, Inc
NPI enumeratedJune 28, 2013
Last updated in NPPESSeptember 6, 2016
Mailing address1160 Varnum St Ne, St Catherine'S Hall, Room 102, Washington, DC 20017-2107

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