Healthcare Provider Details

I. General information

NPI: 1265906994
Provider Name (Legal Business Name): WESTERN MARYLAND HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22221 WESTERNPORT RD SW
WESTERNPORT MD
21562-2206
US

IV. Provider business mailing address

1027 MEMORIAL DR
OAKLAND MD
21550-4343
US

V. Phone/Fax

Practice location:
  • Phone: 240-774-0204
  • Fax: 833-448-0361
Mailing address:
  • Phone: 301-533-3300
  • Fax: 883-448-0361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MICHELLE K DIXON
Title or Position: CEO
Credential: CRNP
Phone: 301-533-3300