Healthcare Provider Details

I. General information

NPI: 1073496063
Provider Name (Legal Business Name): EASTERN SHORE PRIMARY CARE & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CEDAR ST STE 101
CAMBRIDGE MD
21613-2395
US

IV. Provider business mailing address

1505 S SALISBURY BLVD
SALISBURY MD
21801-7128
US

V. Phone/Fax

Practice location:
  • Phone: 410-936-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARTIN MELSON JR.
Title or Position: OWNER/PRESIDENT
Credential: CRNP
Phone: 410-936-5500