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General NPI Number Information
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NPI Number | 1154459949
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Entity Type | Organization
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Legal Business Name | BERKELEY WELLNESS ASSOCIATES
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3327 SUPERIOR LN SUITE 204
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City | BOWIE
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State | MD
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Zip | 20715-1922
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Country | US
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Telephone | 301-860-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 1922 CAMBRIDGE DR
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City | CROFTON
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State | MD
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Zip | 21114-1908
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Country | US
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Telephone | 410-721-2714
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GLENN BRADFORD BERKELEY
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Credential | D.C
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Telephone | 240-476-5684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 02187
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License Number State | MD
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