| Organization Name: | MARYLAND CHILDREN HEALTH CENTER |
| NPI Number: | 1558635235 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY OGUNSANYA (OWNER/PROVIDER) |
| Mailing Address: | 12150 Annapolis Rd Ste 208 Glenn Dale |
| State: | MD US |
| Postal Code: | 207699183 |
| Phone Number: | 3012180398 |
| Fax Number: | 3012180040 |
| NPI Enumeration Date: | 02/28/2012 |
| NPI Last Update Date: | 02/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | D005630 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |