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General NPI Number Information
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NPI Number | 1972311066
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Entity Type | Organization
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Legal Business Name | MEDICAL PARACLETE
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Dates
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Enumeration Date | 12/21/2024
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 6724 GLENKIRK RD
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City | BALTIMORE
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State | MD
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Zip | 21239-1410
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Country | US
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Telephone | 443-900-3184
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Fax | 512-559-7040
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Provider Business Mailing Address
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Address Line | 808 GLENEAGLES CT # 20069
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City | TOWSON
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State | MD
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Zip | 21286-2205
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Country | US
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Telephone | 833-433-8900
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Fax | 512-559-7040
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Authorized Official
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Title or Position | CEO
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Name | DR. WANDA SIMMONS CLEMMONS
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Credential | MD
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Telephone | 443-900-3184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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