Provider Demographics
NPI:1770291023
Name:DORCHESTER HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:DORCHESTER HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LUSCHINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-225-6674
Mailing Address - Street 1:100 BRAMBLE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2471
Mailing Address - Country:US
Mailing Address - Phone:443-225-6674
Mailing Address - Fax:
Practice Address - Street 1:100 BRAMBLE ST STE 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2471
Practice Address - Country:US
Practice Address - Phone:443-255-6674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205447448OtherNPPES
1043875719OtherNPPES