Provider Demographics
NPI:1184139487
Name:BAY AREA WELLNESS GROUP PC
Entity type:Organization
Organization Name:BAY AREA WELLNESS GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-721-5050
Mailing Address - Street 1:2110 PRIEST BRIDGE DR STE 6
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2472
Mailing Address - Country:US
Mailing Address - Phone:410-721-5050
Mailing Address - Fax:443-302-2566
Practice Address - Street 1:2110 PRIEST BRIDGE DR STE 6
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2472
Practice Address - Country:US
Practice Address - Phone:410-721-5050
Practice Address - Fax:443-302-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03878111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty