MEDICARE: CORE HEALTH AND WELLNESS CENTER

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1518207042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE HEALTH AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	2516 SHERIDAN RD SE
Second Line	:	SUITE A
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5265
Country	:	US
Telephone Number	:	202-610-6106
Fax Number	:	202-610-6106

Provider Business Practice Location Address
First Line	:	2516 SHERIDAN RD SE
Second Line	:	SUITE A
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5265
Country	:	US
Telephone Number	:	202-610-6106
Fax Number	:	202-610-6106

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	GLORIA WILDER
Credential	:	MD
Telephone Number	:	202-302-3996

Provider Enumeration Date	:	02/20/2013
Last Update Date	:	02/20/2013

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