=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396612842
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2025
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 SCIENCE PARK
-----------------------------------------------------
City | FROSTBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21532-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-729-2235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 SCIENCE PARK
-----------------------------------------------------
City | FROSTBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21532-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-729-2235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER ENROLLMENT MANAGER
-----------------------------------------------------
Name | PATRICIA ARAYA-CESPEDES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-569-1124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------