Provider Demographics
NPI:1336764026
Name:CENTER FOR FUNCTIONAL MEDICINE & WELLBEING LLC
Entity Type:Organization
Organization Name:CENTER FOR FUNCTIONAL MEDICINE & WELLBEING LLC
Other - Org Name:CENTER FOR WELLBEING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONATELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-451-7438
Mailing Address - Street 1:3201 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6078
Mailing Address - Country:US
Mailing Address - Phone:603-380-9159
Mailing Address - Fax:
Practice Address - Street 1:3201 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6078
Practice Address - Country:US
Practice Address - Phone:603-380-9159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty