MEDICARE: GLEE MED SPA

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	202D00000X	Integrative Medicine Physician

General Provider Information

NPI Number	:	1104605377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEE MED SPA

Provider Business Mailing Address
First Line	:	6510 GARDENWICK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-2538
Country	:	US
Telephone Number	:	410-419-9984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2219 YORK RD STE 103
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21093-3140
Country	:	US
Telephone Number	:	410-826-0800
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SHOSHANA NOURMAND
Credential	:
Telephone Number	:	410-419-9984

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	09/26/2023

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Directions to “GLEE MED SPA ” Practice Location

Language	Start Address	Practice Location

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