MEDICARE: FAMILY MEDICAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1346430550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	1502 S MAIN ST
Second Line	:	SUITE 104
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-5325
Country	:	US
Telephone Number	:	410-489-4927
Fax Number	:	301-829-7907

Provider Business Practice Location Address
First Line	:	1502 S MAIN ST
Second Line	:	SUITE 104
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-5325
Country	:	US
Telephone Number	:	410-489-4927
Fax Number	:	301-829-7907

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ROCHELLE P DYER
Credential	:	C.R.N.P.
Telephone Number	:	410-489-4927

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	06/10/2011

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Directions to “FAMILY MEDICAL CENTER, LLC ” Practice Location

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