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General NPI Number Information
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NPI Number | 1609502590
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Entity Type | Organization
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Legal Business Name | WELLSPRING REALTY CORP
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 2012 S TOLLGATE RD STE 208
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City | BEL AIR
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State | MD
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Zip | 21015-5902
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Country | US
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Telephone | 443-371-9750
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Fax | 443-371-9751
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Provider Business Mailing Address
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Address Line | 2000 GEORGEANNA CT
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City | JARRETTSVILLE
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State | MD
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Zip | 21084-1833
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Country | US
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Telephone | 443-977-9180
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Fax | 443-371-9751
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | NKIRUKA U ARENE
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Credential | MD
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Telephone | 443-977-9180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound 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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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