Provider Demographics
NPI:1619470556
Name:TOTAL RENAISSANCE WELLNESS
Entity Type:Organization
Organization Name:TOTAL RENAISSANCE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDIWE
Authorized Official - Middle Name:FIARRA
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-718-9223
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20763-0363
Mailing Address - Country:US
Mailing Address - Phone:443-718-9223
Mailing Address - Fax:
Practice Address - Street 1:8926 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MD
Practice Address - Zip Code:20763-7549
Practice Address - Country:US
Practice Address - Phone:443-718-9223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty