Healthcare Provider Details

I. General information

NPI: 1831891282
Provider Name (Legal Business Name): CARONETTE FIBROID & PELVIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11886 HEALING WAY STE 520
SILVER SPRING MD
20904-7917
US

IV. Provider business mailing address

11406 DAIRY ST
FULTON MD
20759-2661
US

V. Phone/Fax

Practice location:
  • Phone: 706-662-3129
  • Fax:
Mailing address:
  • Phone: 706-662-3129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OTIS LAWRENCE SITT III
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 706-662-3129