Healthcare Provider Details

I. General information

NPI: 1194744359
Provider Name (Legal Business Name): WELLSPRING FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N 4TH ST STE 1
OAKLAND MD
21550-1371
US

IV. Provider business mailing address

311 N 4TH ST SUITE 1
OAKLAND MD
21550-1395
US

V. Phone/Fax

Practice location:
  • Phone: 301-334-7855
  • Fax: 833-398-2061
Mailing address:
  • Phone: 301-334-7855
  • Fax: 301-334-7828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001983
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0064705
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0061801
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0061801
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH0064705
License Number StateMD

VIII. Authorized Official

Name: SHAINA SATURDAY
Title or Position: CFO
Credential:
Phone: 301-334-7855