CIVISTA CLINICAL SERVICES LLC NPI 1205035805

NPI Information

  • NPI: 1205035805
  • Provider Name: CIVISTA CLINICAL SERVICES, LLC
  • Classification: Obstetrics & Gynecology - 207V00000X
  • Entity Type: Organization
  • Doing Business As: UNIVERSITY OF MARYLAND CHARLES REGIONAL OB/GYN
  • Address: 605 EAST CHARLES STREET
    LA PLATA, MD
    ZIP 20646
  • Phone: (301) 609-4800

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NPI Details

CIVISTA CLINICAL SERVICES, LLC is an obstetrics gynecology in La Plata, MD. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. CIVISTA CLINICAL SERVICES, LLC NPI is 1205035805. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As University Of Maryland Charles Regional Ob/gyn.

The provider's business location address is:

605 EAST CHARLES STREET
LA PLATA, MD
ZIP 20646
Phone: (301) 609-4800
Fax: (301) 609-5220

The provider's authorized official is Stephanie Simm .
The authorized official title is Physician Relations Specialists and has the following contact phone number (301) 609-4539.

The enumeration date for this NPI number is 7/13/2007 and was last updated on 5/15/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & GynecologyYes

What is NPI?

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This page was last updated on: 11/21/2025

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