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General NPI Number Information
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NPI Number | 1912457821
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Entity Type | Organization
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Legal Business Name | MANCHESTER MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 2111 HANOVER PIKE FL 1
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City | HAMPSTEAD
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State | MD
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Zip | 21074-1319
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Country | US
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Telephone | 410-374-9500
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Fax | 410-374-5311
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Provider Business Mailing Address
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Address Line | 2111 HANOVER PIKE FL 1
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City | HAMPSTEAD
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State | MD
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Zip | 21074-1319
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Country | US
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Telephone | 410-374-9500
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Fax | 410-374-5311
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DIXIE L COLGAN
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Credential | CRNP
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Telephone | 443-255-6417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | SP014888
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License Number State | PA
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