MEDICARE: PRECISION WELLNESS GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1487168696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION WELLNESS GROUP

Provider Business Mailing Address
First Line	:	5529 PHELPS LUCK DR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2554
Country	:	US
Telephone Number	:	301-873-8292
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 CENTRAL AVE STE 204
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-4868
Country	:	US
Telephone Number	:	301-333-3770
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ROBERT KENNEDY JR.
Credential	:	MD
Telephone Number	:	301-873-8292

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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Directions to “PRECISION WELLNESS GROUP ” Practice Location

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