Provider Demographics
NPI:1821533423
Name:FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-489-4927
Mailing Address - Street 1:202 WARFIELDSBURG RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6915
Mailing Address - Country:US
Mailing Address - Phone:443-244-2598
Mailing Address - Fax:
Practice Address - Street 1:202 WARFIELDSBURG RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6915
Practice Address - Country:US
Practice Address - Phone:443-244-2598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR089671261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care