Healthcare Provider Details

I. General information

NPI: 1790042950
Provider Name (Legal Business Name): UPMC WESTERN MARYLAND CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 WILLOWBROOK RD
CUMBERLAND MD
21502-6393
US

IV. Provider business mailing address

12500 WILLOWBROOK RD
CUMBERLAND MD
21502-6393
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-2522
  • Fax:
Mailing address:
  • Phone: 240-964-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number058
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMBER R RUBLE
Title or Position: SR. VP CFO
Credential:
Phone: 240-964-8032