Healthcare Provider Details

I. General information

NPI: 1467774547
Provider Name (Legal Business Name): CORE HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 SHERIDAN RD SE STE A
WASHINGTON DC
20020-5265
US

IV. Provider business mailing address

2516 SHERIDAN RD SE STE A
WASHINGTON DC
20020-5265
US

V. Phone/Fax

Practice location:
  • Phone: 202-610-6106
  • Fax: 202-610-6107
Mailing address:
  • Phone: 202-610-6106
  • Fax: 202-610-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GLORIA WILDER
Title or Position: CEO
Credential: MD
Phone: 202-610-6106