Provider Demographics
NPI:1952322448
Name:WELLBERY, CAROLINE ELISABETH (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELISABETH
Last Name:WELLBERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5301 WESTBARD CIR
Mailing Address - Street 2:#417
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1401
Mailing Address - Country:US
Mailing Address - Phone:301-913-9143
Mailing Address - Fax:
Practice Address - Street 1:803 RUSSELL AVE # 1
Practice Address - Street 2:SECURE MEDICAL CARE
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3584
Practice Address - Country:US
Practice Address - Phone:301-869-0700
Practice Address - Fax:301-947-9513
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0046323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0046323OtherPROFESSIONAL LICENSE
MDG74200Medicare UPIN
MD00146P77Medicare ID - Type Unspecified