Provider Demographics
NPI:1184176851
Name:PRINCE GEORGE'S HOSPITAL CENTER
Entity type:Organization
Organization Name:PRINCE GEORGE'S HOSPITAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TESHOME
Authorized Official - Middle Name:
Authorized Official - Last Name:TEGENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-590-5104
Mailing Address - Street 1:3500 DEAN DRIVE,
Mailing Address - Street 2:APT K3
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782
Mailing Address - Country:US
Mailing Address - Phone:201-590-5104
Mailing Address - Fax:
Practice Address - Street 1:3500 DEAN DRIVE,
Practice Address - Street 2:APT K3
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782
Practice Address - Country:US
Practice Address - Phone:201-590-5104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty