MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC – NPI #1265363956
Clinic/Center

MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC is an AHC clinic located in HOLLYWOOD, MD. NPPES recently assigned the NPI number 1265363956 to MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC on May 29, 2026. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QA1903X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Ambulatory Surgical

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC below.

NPI Profile for
MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC

NPI Number
1265363956
Enumeration Date

(about a week ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC
Primary location
24035 THREE NOTCH ROAD
HOLLYWOOD, MD 20636-4871
Phone: (301) 373-7900 Fax: (301) 373-6900
Mailing address
24035 THREE NOTCH RD
HOLLYWOOD, MD 20636-4871
Phone: (301) 373-7900 Fax: (301) 373-6900
Organization Subpart
No
Authorized Official
ALAN BUSTER
C.O.O.
Phone: (301) 373-7905
Updated
Certification Date
May 29, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for MEDSTAR MEDICAL GROUP - SOUTHERN MARYLAND LLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidMD423411100
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QA1903X
- Clinic/Center / Ambulatory Surgical (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.