MEDICARE: WELLSPRING RELEASE, LLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1699582833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING RELEASE, LLC

Provider Business Mailing Address
First Line	:	21 TREWORTHY RD
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-2620
Country	:	US
Telephone Number	:	301-315-5816
Fax Number	:

Provider Business Practice Location Address
First Line	:	10810 DARNESTOWN RD STE 102
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-2604
Country	:	US
Telephone Number	:	240-780-8344
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIA DELGIORNO
Credential	:	MD
Telephone Number	:	240-372-2544

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2024

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