OrganizationActive
Phs Glenn Dale
NPI 1487922803 · Surgery Physician · Glenn Dale, MD
Phs Glenn Dale is a Surgery Physician organization in Glenn Dale, MD (NPI 1487922803).
Provider details
- NPI number
- 1487922803
- Entity type
- Organization
- Primary specialty
- Surgery PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Providence Hospital
- Organization subpart
- Yes
- Authorized official
- Beau Higginbotham, Vice President/Coo(410) 368-3162
- License
- HFD01-0212 (DC)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Hospitals
Profile Score
Detailed profile(80/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
12200 Annapolis Rd
Suite 123
Glenn Dale, MD 20769-9182
Phone: (202) 448-4014
Fax: (202) 372-0029
Street-level locationGet directions
Mailing address
1160 Varnum St Ne
Washington, DC 20017-2107
Other names (DBA / former)
- Other name
- Providence Health Services
Registry dates
- Enumerated
- 2011-12-13
- Last updated
- 2017-10-09
Frequently asked questions
- What is Phs Glenn Dale's NPI number?
- Phs Glenn Dale's National Provider Identifier (NPI) is 1487922803, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Phs Glenn Dale?
- Phs Glenn Dale is classified in the NPPES registry as Surgery Physician (Allopathic & Osteopathic Physicians).
- Where is Phs Glenn Dale located?
- Phs Glenn Dale's practice location on file with NPPES is 12200 Annapolis Rd, Glenn Dale, MD 20769-9182.
- What is Phs Glenn Dale's phone number?
- The practice phone number listed in the NPPES registry for Phs Glenn Dale is (202) 448-4014.
- Who is the authorized official for Phs Glenn Dale?
- The authorized official listed on Phs Glenn Dale's NPPES record is Beau Higginbotham, Vice President/Coo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Phs Glenn Dale's NPI active?
- Yes — Phs Glenn Dale's NPI (1487922803) is active in the NPPES registry as of the last update on 2017-10-09.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.