Organization
WELLINGTON PROVIDER GROUP PC
Active
Parent organization
WELLINGTON PROVIDER GROUP PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLINGTON PROVIDER GROUP PC
Authorized official
MARIELA BRAVO (CREDENTIALING TEAM LEAD)
(859) 518-8817
Entity
Organization
Contact information
Practice address
145 W OSTEND ST STE 600, BALTIMORE, MD 21230-3774
(859) 518-8817
(859) 201-1084
Mailing address
535 WELLINGTON WAY STE 330, LEXINGTON, KY 40503-1331
(859) 518-8817
(859) 201-1084
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/20/2022
Last updated
12/20/2022
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