Healthcare Provider Details

I. General information

NPI: 1720577026
Provider Name (Legal Business Name): BRAVERMAN WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 WYNDHURST AVE
BALTIMORE MD
21210-2416
US

IV. Provider business mailing address

4301 BUCHANAN AVE APT B
BALTIMORE MD
21211-1216
US

V. Phone/Fax

Practice location:
  • Phone: 443-956-3163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEREMY BRAVERMAN
Title or Position: OWNER AND PROVIDER
Credential: LAC
Phone: 720-201-4729