Provider Demographics
NPI:1083998074
Name:METROPOLITAN WELLNESS SPECIALISTS, LLC
Entity Type:Organization
Organization Name:METROPOLITAN WELLNESS SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ROQUELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WYCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-812-4933
Mailing Address - Street 1:1015 I ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3747
Mailing Address - Country:US
Mailing Address - Phone:202-499-6999
Mailing Address - Fax:202-331-7013
Practice Address - Street 1:1120 19TH ST NW
Practice Address - Street 2:SUITE 316
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3605
Practice Address - Country:US
Practice Address - Phone:202-499-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-08
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33157207RB0002X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC040147900Medicaid
DC184985Medicare PIN