Healthcare Provider Details

I. General information

NPI: 1275326126
Provider Name (Legal Business Name): NU PATHWAY HEALTHCARE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 TRADITIONS BLVD
BOWIE MD
20720-3658
US

IV. Provider business mailing address

14300 GALLANT FOX LN STE 202
BOWIE MD
20715-4033
US

V. Phone/Fax

Practice location:
  • Phone: 202-932-8149
  • Fax: 301-291-7071
Mailing address:
  • Phone: 202-932-8149
  • Fax: 301-291-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: OWEN GARDNER
Title or Position: OWNER
Credential:
Phone: 301-928-4725