Provider Demographics
NPI:1972311066
Name:MEDICAL PARACLETE
Entity type:Organization
Organization Name:MEDICAL PARACLETE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS CLEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-900-3184
Mailing Address - Street 1:808 GLENEAGLES CT # 20069
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2205
Mailing Address - Country:US
Mailing Address - Phone:833-433-8900
Mailing Address - Fax:512-559-7040
Practice Address - Street 1:6724 GLENKIRK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-1410
Practice Address - Country:US
Practice Address - Phone:443-900-3184
Practice Address - Fax:512-559-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty