MEDICARE: WELLNESS CUBE LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1790417772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS CUBE LLC

Provider Business Mailing Address
First Line	:	9131 PISCATAWAY RD STE 150
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2510
Country	:	US
Telephone Number	:	202-459-2122
Fax Number	:	301-842-9021

Provider Business Practice Location Address
First Line	:	9131 PISCATAWAY RD STE 150
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2510
Country	:	US
Telephone Number	:	202-365-1120
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAMEKA NICOLE GABOUREL-ANTHONY
Credential	:
Telephone Number	:	202-459-2122

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	03/20/2026

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Directions to “WELLNESS CUBE LLC ” Practice Location

Language	Start Address	Practice Location

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