Provider Demographics
NPI:1902923634
Name:DORCHESTER COUNTY WELLNESS CENTER PROGRAM
Entity Type:Organization
Organization Name:DORCHESTER COUNTY WELLNESS CENTER PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER, DORCHESTER CO HDEPT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-228-3223
Mailing Address - Street 1:3 CEDAR ST
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:410-228-3223
Mailing Address - Fax:
Practice Address - Street 1:1101 MACES LN
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2619
Practice Address - Country:US
Practice Address - Phone:410-228-0973
Practice Address - Fax:410-228-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare