Provider Demographics
NPI:1104013671
Name:MEDICAL AND WELLNESS CENTER OF OLNEY
Entity Type:Organization
Organization Name:MEDICAL AND WELLNESS CENTER OF OLNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-774-2506
Mailing Address - Street 1:4000 OLNEY-LAYTONSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1802
Mailing Address - Country:US
Mailing Address - Phone:301-774-2506
Mailing Address - Fax:301-774-3734
Practice Address - Street 1:4000 OLNEY-LAYTONSVILLE RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1802
Practice Address - Country:US
Practice Address - Phone:301-774-2506
Practice Address - Fax:301-774-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055694207R00000X
MDD0056132207R00000X
MDD0055931207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH12146Medicare UPIN