| Dorchester Family Medicine, Llc | |
|
300 Dorchester Ave Cambridge MD 21613-2420 | |
| (410) 228-2603 | |
| Not Available |
| Full Name | Dorchester Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 300 Dorchester Ave, Cambridge, Maryland |
| Authorized Official Name and Position | Sara Coulbourn (OWNER) |
| Authorized Official Contact | 4102282603 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dorchester Family Medicine, Llc 1518 Gary Creek Rd Cambridge MD 21613-3312 Ph: () - | Dorchester Family Medicine, Llc 300 Dorchester Ave Cambridge MD 21613-2420 Ph: (410) 228-2603 |
| NPI Number | 1912484668 |
|---|---|
| Provider Enumeration Date | 07/25/2018 |
| Last Update Date | 07/25/2018 |
| Medicare PECOS PAC ID | 3577809482 |
|---|---|
| Medicare Enrollment ID | O20190115000802 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912484668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D0080826 (Maryland) | Primary |
| Provider Name | Sara Wozny Coulbourn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780020289 PECOS PAC ID: 9436471828 Enrollment ID: I20160812000337 |
| Provider Name | Lauren C Samuel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336647056 PECOS PAC ID: 1052674835 Enrollment ID: I20180409000599 |
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