Healthcare Provider Details

I. General information

NPI: 1083998074
Provider Name (Legal Business Name): METROPOLITAN WELLNESS SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 19TH ST NW SUITE 316
WASHINGTON DC
20036-3605
US

IV. Provider business mailing address

1015 I ST NE
WASHINGTON DC
20002-3747
US

V. Phone/Fax

Practice location:
  • Phone: 202-499-6999
  • Fax:
Mailing address:
  • Phone: 202-499-6999
  • Fax: 202-331-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberMD33157
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD33157
License Number StateDC

VIII. Authorized Official

Name: ROQUELL WYCHE
Title or Position: SOLO PROPRIETOR
Credential:
Phone: 202-812-4933