Provider Demographics
NPI:1265906994
Name:WESTERN MARYLAND HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:WESTERN MARYLAND HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-533-3300
Mailing Address - Street 1:1027 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4343
Mailing Address - Country:US
Mailing Address - Phone:301-533-3300
Mailing Address - Fax:301-533-3299
Practice Address - Street 1:22221 WESTERNPORT RD SW
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562-2206
Practice Address - Country:US
Practice Address - Phone:240-774-0204
Practice Address - Fax:833-448-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410467600Medicaid
WV3810007182Medicaid
PA1030070260002Medicaid
MD7118OtherCAREFIRST BC/BS