Healthcare Provider Details

I. General information

NPI: 1497528632
Provider Name (Legal Business Name): WELL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 09/02/2025
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 OSLER DR STE 113
TOWSON MD
21204-7705
US

IV. Provider business mailing address

7600 OSLER DR STE 113
TOWSON MD
21204-7705
US

V. Phone/Fax

Practice location:
  • Phone: 708-704-1955
  • Fax:
Mailing address:
  • Phone: 708-704-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RUSHIA BUTLER
Title or Position: CEO
Credential: MD
Phone: 708-704-1955