Provider Demographics
NPI:1205894458
Name:DORCHESTER COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:DORCHESTER COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MHS,CPP
Authorized Official - Phone:410-228-7714
Mailing Address - Street 1:3 CEDAR STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2362
Mailing Address - Country:US
Mailing Address - Phone:410-228-7714
Mailing Address - Fax:410-228-8049
Practice Address - Street 1:310 GAY STREET
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1898
Practice Address - Country:US
Practice Address - Phone:410-228-7714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DORCHESTER COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-03
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD-902199251K00000X
MD13090251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD703191200OtherUNITED BEHAVORIAL HEALTH
MDMV4OtherBLUE CROSS/BLUE SHEILD
MD703191200OtherMEDICAL ASSISTANCE
MD720081100Medicaid
MD703191200OtherPRIORITY PARTNERS
MD703191200OtherAMERIGROUP
MD703191200OtherMD PHYSICIANS CARE
MD005FMedicare PIN
MDVA05Medicare UPIN
MD703191200OtherUNITED BEHAVORIAL HEALTH