Provider Demographics
NPI:1508946047
Name:WICOMICO COUNTY HEALTH DEPT
Entity Type:Organization
Organization Name:WICOMICO COUNTY HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,APRN/BC,LCADC
Authorized Official - Phone:410-543-6930
Mailing Address - Street 1:108 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4921
Mailing Address - Country:US
Mailing Address - Phone:410-543-6931
Mailing Address - Fax:410-543-6975
Practice Address - Street 1:705 N SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4120
Practice Address - Country:US
Practice Address - Phone:410-334-3401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400155900Medicaid
MD901100360OtherDORAL DENTAL
MD113970-1OtherDENTAL BENEFIT PROVIDER
MD409012800Medicaid