Provider Demographics
NPI:1437957388
Name:CAREWAY SOUTHERN MARYLAND CLINIC LLC
Entity type:Organization
Organization Name:CAREWAY SOUTHERN MARYLAND CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-565-2250
Mailing Address - Street 1:3460 OLD WASHINGTON RD STE 203A
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3243
Mailing Address - Country:US
Mailing Address - Phone:301-638-9670
Mailing Address - Fax:
Practice Address - Street 1:3460 OLD WASHINGTON RD STE 203A
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3243
Practice Address - Country:US
Practice Address - Phone:301-638-9670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty