Provider Demographics
NPI:1740732262
Name:TOTAL WELLNESS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:TOTAL WELLNESS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-808-0341
Mailing Address - Street 1:4000 MITCHEVILLE ROAD
Mailing Address - Street 2:B322
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-0000
Mailing Address - Country:US
Mailing Address - Phone:301-808-0341
Mailing Address - Fax:301-263-6860
Practice Address - Street 1:4000 MITCHEVILLE ROAD
Practice Address - Street 2:B322
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-0000
Practice Address - Country:US
Practice Address - Phone:301-808-0341
Practice Address - Fax:301-263-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040898146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty