Healthcare Provider Details

I. General information

NPI: 1588785471
Provider Name (Legal Business Name): WESTERN MARYLAND HEALTH SYSTEM BRADDOCK HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E OLDTOWN RD
CUMBERLAND MD
21502-3600
US

IV. Provider business mailing address

300 E OLDTOWN RD
CUMBERLAND MD
21502-3600
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-0199
  • Fax: 301-759-3623
Mailing address:
  • Phone: 301-722-0199
  • Fax: 301-759-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: KIMBERLY S REPAC
Title or Position: SR VP CFO
Credential:
Phone: 301-723-6414