MEDICARE: PRIMEWELL MEDICAL & WELLNESS 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1861331266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMEWELL MEDICAL & WELLNESS LLC

Provider Business Mailing Address
First Line	:	5121 GOOD MEMORY LN
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-7509
Country	:	US
Telephone Number	:	443-766-0326
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 GOOD MEMORY LN
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-7509
Country	:	US
Telephone Number	:	443-766-0326
Fax Number	:

Authorized Official
Title or Position	:	OWNER / MANAGING MEMBER
Name	:	MRS. CUIQIONG DU
Credential	:	FNP-C
Telephone Number	:	443-766-0326

Provider Enumeration Date	:	03/28/2026
Last Update Date	:	03/28/2026

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