MEDICARE: TELEMED WEIGHT LOSS & DIABETES MANAGEMENT, 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1780530014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELEMED WEIGHT LOSS & DIABETES MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	5457 TWIN KNOLLS RD STE 300
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3296
Country	:	US
Telephone Number	:	561-633-7416
Fax Number	:

Provider Business Practice Location Address
First Line	:	5457 TWIN KNOLLS RD STE 300 #1123
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3296
Country	:	US
Telephone Number	:	561-633-7416
Fax Number	:

Authorized Official
Title or Position	:	OWNER & MANAGING MEMBER
Name	:	CLAIRE L CHARLES
Credential	:	CRNP, FNP-C
Telephone Number	:	561-633-7416

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/10/2026

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