Healthcare Provider Details

I. General information

NPI: 1164370441
Provider Name (Legal Business Name): DUNDALK HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 TRIBUTARY ST STE 310
BALTIMORE MD
21224-6514
US

IV. Provider business mailing address

6610 TRIBUTARY ST STE 310
BALTIMORE MD
21224-6514
US

V. Phone/Fax

Practice location:
  • Phone: 443-628-6956
  • Fax: 443-628-6947
Mailing address:
  • Phone: 443-628-6956
  • Fax: 443-628-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IRIS JACKSON
Title or Position: DIRECTOR
Credential: PHD, LCSW-C
Phone: 443-628-6956