Healthcare Provider Details

I. General information

NPI: 1427775329
Provider Name (Legal Business Name): SAILWINDS MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 FRIENDSHIP RD
PITTSVILLE MD
21850-2045
US

IV. Provider business mailing address

6640 FRIENDSHIP RD
PITTSVILLE MD
21850-2045
US

V. Phone/Fax

Practice location:
  • Phone: 443-521-6638
  • Fax:
Mailing address:
  • Phone: 443-521-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON MCMULLEN
Title or Position: PRESIDENT
Credential: PA-C
Phone: 443-521-6638