Provider Demographics
NPI:1669985248
Name:PR HOUSE CALLS
Entity type:Organization
Organization Name:PR HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWNE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-818-1243
Mailing Address - Street 1:12138 CENTRAL AVE # 953
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1910
Mailing Address - Country:US
Mailing Address - Phone:301-818-1243
Mailing Address - Fax:240-435-2692
Practice Address - Street 1:14408 WOODMORE OAKS CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1910
Practice Address - Country:US
Practice Address - Phone:301-818-1243
Practice Address - Fax:240-435-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00042719207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD182901700Medicaid