Provider Demographics
NPI:1912667734
Name:WELLCARE INC
Entity Type:Organization
Organization Name:WELLCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-268-4064
Mailing Address - Street 1:1226 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7603
Mailing Address - Country:US
Mailing Address - Phone:301-709-0357
Mailing Address - Fax:
Practice Address - Street 1:1226 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-7603
Practice Address - Country:US
Practice Address - Phone:301-729-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000000000OtherWELLCARE