Provider Demographics
NPI:1407034549
Name:WELLNESS MEDICIAL CENTER LLC
Entity Type:Organization
Organization Name:WELLNESS MEDICIAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-942-7900
Mailing Address - Street 1:10901 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1645
Mailing Address - Country:US
Mailing Address - Phone:301-942-7900
Mailing Address - Fax:301-942-9837
Practice Address - Street 1:10901 CONNECTICUT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1645
Practice Address - Country:US
Practice Address - Phone:301-942-7900
Practice Address - Fax:301-942-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD133505OtherPTAN
MD133515ZA1XOtherPTAN
MDD0053615OtherSTATE LICENSE
MD133518ZA1XOtherPTAN
MDD0057879OtherSTATE LICENSE