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General NPI Number Information
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NPI Number | 1255791976
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Entity Type | Organization
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Legal Business Name | INTEGRATED WELLNESS DC, LLC
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 1800 M ST NW
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City | WASHINGTON
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State | DC
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Zip | 20036
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Country | US
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Telephone | 800-762-6282
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Fax |
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Provider Business Mailing Address
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Address Line | 9755 PATUXENT WOODS DR STE 100
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City | COLUMBIA
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State | MD
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Zip | 21046-2286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARL DOUGLAS LORD
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Credential | M.D.
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Telephone | 301-502-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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