1033542279 NPI number — WESTERN MARYLAND HEALTH SYSTEM CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033542279 NPI number — WESTERN MARYLAND HEALTH SYSTEM CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MARYLAND HEALTH SYSTEM CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIABETIC OUTPATIENT COUNSELING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033542279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12500 WILLOWBROOK RD
Provider Second Line Business Mailing Address:
3RD FLOOR, BUSINESS OFFICE
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-6393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-964-8342
Provider Business Mailing Address Fax Number:
240-964-8337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12502 WILLOWBROOK RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-6491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-964-8342
Provider Business Practice Location Address Fax Number:
240-964-8337
Provider Enumeration Date:
08/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
REPAC
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SR. VP/CFO
Authorized Official Telephone Number:
240-964-8342

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  01-007 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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