Healthcare Provider Details

I. General information

NPI: 1790236297
Provider Name (Legal Business Name): UPTOWN CENTRAL WELLNESS P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 2ND ST SE SUITE 100
WASHINGTON DC
20003-1943
US

IV. Provider business mailing address

208 2ND ST SE SUITE 100
WASHINGTON DC
20003-1943
US

V. Phone/Fax

Practice location:
  • Phone: 202-618-2153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name: DUNCAN SMITH P.C.
Title or Position: CUSTODIAN OF RECORDS
Credential:
Phone: 202-618-2153