MEDICARE: WELLNESS MANAGEMENT INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine

General Provider Information

NPI Number	:	1043210958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS MANAGEMENT INC.

Provider Business Mailing Address
First Line	:	1460 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-1343
Country	:	US
Telephone Number	:	617-282-8700
Fax Number	:	617-282-7400

Provider Business Practice Location Address
First Line	:	1460 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-1343
Country	:	US
Telephone Number	:	617-282-8700
Fax Number	:	617-282-7400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALEX KHOTINER
Credential	:
Telephone Number	:	617-282-8700

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/22/2020

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