Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum Organization subpart

Phs Family Medicine Glenn Dale

Family Medicine Physician in Glenn Dale, MD · enumerated 2013 · authorized official Charles Haberkern, Vp.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1962842401

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Registry record

Entity type Organization (Type 2)

Legal business name Phs Family Medicine Glenn Dale

Other name <Unavail>

Parent organization Providence Hospital

Practice address 12200 Annapolis Rd, Suite 118, Glenn Dale, MD, 20769

Phone (301) 464-9300

Fax (202) 854-4093

Enumeration date Jun 28, 2013

Last updated in NPPES Sep 6, 2016

Taxonomy & classification

207Q00000X Family Medicine Physician Allopathic & Osteopathic Physicians · License HFD01-0212 (DC) Primary

282N00000X General Acute Care Hospital Hospitals · License HFD01-0212 (DC) Secondary

Authorized official

Name Charles Haberkern

Title Vp

Phone (202) 854-4255

Other identifiers

Identifier	Type	State	Issuer
029833400	Medicaid	DC	-
09810714	Medicaid	VA	-
005145400	Medicaid	MD	-

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2016-09-06. Verify at npiregistry.cms.hhs.gov.

Where is Phs Family Medicine Glenn Dale located?

The practice location on file with NPPES is in Glenn Dale, MD.

Providers at this address

Browse all →

Ikechi Okwara Internal Medicine Physician · Glenn Dale, MD NPI 1265472567 Kwasi Debra Gynecology Physician · Glenn Dale, MD NPI 1972512408 Mukemil Abdella Internal Medicine Physician · Glenn Dale, MD NPI 1871603381 Renee Bovelle Ophthalmology Physician · Glenn Dale, MD NPI 1588732424 Mukemil Abdella MD LLC Internal Medicine Physician · Glenn Dale, MD NPI 1376604926 Larry Bryant Oral and Maxillofacial Pathology Dentistry · Glenn Dale, MD NPI 1902960958 Valerie Callender Dermatology Physician · Glenn Dale, MD NPI 1245389717 Vanessa Allen Family Medicine Physician · Glenn Dale, MD NPI 1912059320

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2016-09-06.