Healthcare Provider Details

I. General information

NPI: 1699006080
Provider Name (Legal Business Name): WELLINGTON MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WELLINGTON PL 1ST FLOOR
CINCINNATI OH
45219-1758
US

IV. Provider business mailing address

111 WELLINGTON PL 1ST FLOOR
CINCINNATI OH
45219-1758
US

V. Phone/Fax

Practice location:
  • Phone: 513-621-0007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LUIS F PAGANI
Title or Position: PRESIDENT
Credential: MD
Phone: 513-621-0007