Organization
WESTERN MARYLAND HEALTH SYSTEM BRADDOCK HOSPITAL CORPORATION
Active
Parent organization
WESTERN MARYLAND HEALTH SYSTEM BRADDOCK HOSPITAL CORPORATION
Other names
WMHS Cardiac and Thoracic Surgical Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN MARYLAND HEALTH SYSTEM BRADDOCK HOSPITAL CORPORATION
Authorized official
PROF. KIMBERLY S. REPAC (SR. VP CFO)
(301) 723-1443
Entity
Organization
Contact information
Practice address
902 SETON DR, SUITE 204, CUMBERLAND, MD 21502-1873
(301) 723-6365
(301) 723-6277
Mailing address
902 SETON DR, SUITE 204, CUMBERLAND, MD 21502-1873
(301) 723-6365
(301) 723-6277
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001708660
MT. STATE BC BS
WV
05
—
7741413-01
—
MD
05
—
774141303
—
MD
05
—
774141304
—
MD
01
—
CA5993 CH3960 CE790
TRAVELERS MEDICARE
MD
01
—
G362
FEDERAL BC BS
DC
01
—
K936SE
BC BS MD
MD
Enumeration date
12/08/2006
Last updated
06/12/2008
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