Provider Demographics
NPI:1124423637
Name:EUCENTRICS URGENT CARE AND WELLNESS CENTER
Entity type:Organization
Organization Name:EUCENTRICS URGENT CARE AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDYL
Authorized Official - Middle Name:ERIK
Authorized Official - Last Name:GESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:301-662-6478
Mailing Address - Street 1:1100 W PATRICK ST STE H
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-3974
Mailing Address - Country:US
Mailing Address - Phone:301-662-6478
Mailing Address - Fax:
Practice Address - Street 1:1100 W PATRICK ST STE H
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-3974
Practice Address - Country:US
Practice Address - Phone:301-662-6478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU0213171100000X
MDC04452363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12236488OtherCAQH