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General NPI Number Information
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NPI Number | 1720928260
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Entity Type | Organization
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Legal Business Name | SOLUNA VITALITY, LLC
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 15948 FREDERICK RD
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City | WOODBINE
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State | MD
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Zip | 21797-8526
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Country | US
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Telephone | 301-664-4280
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Fax |
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Provider Business Mailing Address
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Address Line | 15948 FREDERICK RD
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City | WOODBINE
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State | MD
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Zip | 21797-8526
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Country | US
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Telephone | 301-664-4280
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Fax |
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Authorized Official
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Title or Position | OWNER AND MEDICAL DIRECTOR
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Name | DR. ANDREA CERESA RIDGEWAY
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Credential | DO
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Telephone | 443-569-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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