Healthcare Provider Details

I. General information

NPI: 1972311066
Provider Name (Legal Business Name): MEDICAL PARACLETE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6724 GLENKIRK RD
BALTIMORE MD
21239-1410
US

IV. Provider business mailing address

808 GLENEAGLES CT # 20069
TOWSON MD
21286-2205
US

V. Phone/Fax

Practice location:
  • Phone: 443-900-3184
  • Fax: 512-559-7040
Mailing address:
  • Phone: 833-433-8900
  • Fax: 512-559-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: DR. WANDA SIMMONS CLEMMONS
Title or Position: CEO
Credential: MD
Phone: 443-900-3184