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General NPI Number Information
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NPI Number | 1720577026
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Entity Type | Organization
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Legal Business Name | BRAVERMAN WELLNESS
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 314 WYNDHURST AVE
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City | BALTIMORE
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State | MD
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Zip | 21210-2416
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Country | US
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Telephone | 443-956-3163
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 BUCHANAN AVE APT B
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City | BALTIMORE
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State | MD
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Zip | 21211-1216
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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 AND PROVIDER
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Name | JEREMY BRAVERMAN
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Credential | LAC
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Telephone | 720-201-4729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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