Healthcare Provider Details

I. General information

NPI: 1124423637
Provider Name (Legal Business Name): EUCENTRICS URGENT CARE AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W PATRICK ST STE H
FREDERICK MD
21703-3974
US

IV. Provider business mailing address

1100 W PATRICK ST STE H
FREDERICK MD
21703-3974
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-6478
  • Fax:
Mailing address:
  • Phone: 301-662-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU0213
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC04452
License Number StateMD

VIII. Authorized Official

Name: RANDYL ERIK GESSEL
Title or Position: PRESIDENT
Credential: PA-C
Phone: 301-662-6478