Provider Demographics
NPI:1013457340
Name:WELLINGTONMD, LLC
Entity Type:Organization
Organization Name:WELLINGTONMD, LLC
Other - Org Name:WELLINGTONMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-987-2445
Mailing Address - Street 1:12989 SOUTHERN BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9205
Mailing Address - Country:US
Mailing Address - Phone:561-268-2880
Mailing Address - Fax:
Practice Address - Street 1:12989 SOUTHERN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-268-2880
Practice Address - Fax:561-268-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty