Provider Demographics
NPI:1851582027
Name:HEALTHWISE MEDICINE LLC
Entity Type:Organization
Organization Name:HEALTHWISE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KALVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-821-8087
Mailing Address - Street 1:8501 LASALLE RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5914
Mailing Address - Country:US
Mailing Address - Phone:410-821-8087
Mailing Address - Fax:410-821-9001
Practice Address - Street 1:8501 LASALLE RD
Practice Address - Street 2:SUITE #102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5914
Practice Address - Country:US
Practice Address - Phone:410-821-8087
Practice Address - Fax:410-821-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM49995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ203OtherGHMSI
MDJ2030000OtherBCBS FEDERAL
MD6813038 00Medicaid
MD6902000000KFD6OtherCAREFIRST BCBS
MDJ2030000OtherBCBS FEDERAL