Provider Demographics
NPI:1588316103
Name:WELLCARE MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:WELLCARE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-875-3766
Mailing Address - Street 1:2524 AYR CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1682
Mailing Address - Country:US
Mailing Address - Phone:443-875-3766
Mailing Address - Fax:
Practice Address - Street 1:1438 DEFENSE HWY STE 102
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-2021
Practice Address - Country:US
Practice Address - Phone:443-875-3766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care