Healthcare Provider Details

I. General information

NPI: 1063224327
Provider Name (Legal Business Name): SPECIALTY PHYSICIANS OF GARRETT COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N 4TH ST STE 3
OAKLAND MD
21550-1371
US

IV. Provider business mailing address

PO BOX 1647
MORGANTOWN WV
26507-1647
US

V. Phone/Fax

Practice location:
  • Phone: 301-334-1034
  • Fax: 301-334-3350
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: LORI DIXON
Title or Position: DIRECTOR, FINANCE
Credential:
Phone: 301-533-4251