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General NPI Number Information
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NPI Number | 1477453173
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Entity Type | Organization
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Legal Business Name | BODYWISE HEALTH LLC
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 4853 CORDELL AVE PH 10
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City | BETHESDA
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State | MD
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Zip | 20814-3036
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Country | US
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Telephone | 240-262-3194
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Fax | 240-655-0648
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Provider Business Mailing Address
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Address Line | 4853 CORDELL AVE PH 10
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City | BETHESDA
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State | MD
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Zip | 20814-3036
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Country | US
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Telephone | 240-262-3194
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Fax | 240-655-0648
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | STACY HOM
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Credential | MD
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Telephone | 310-400-2253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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