Provider Demographics
NPI:1447325154
Name:WELLS MD, J. RICHARD
Entity type:Individual
Prefix:
First Name:J.
Middle Name:RICHARD
Last Name:WELLS MD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVENUE
Mailing Address - Street 2:SUITE 1550
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-6612
Mailing Address - Fax:301-654-2746
Practice Address - Street 1:5530 WISCONSIN AVENUE
Practice Address - Street 2:SUITE 1550
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-6612
Practice Address - Fax:301-654-2746
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD27243174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD074470W76Medicare PIN
MDD09306Medicare UPIN