Provider Demographics
NPI:1487416137
Name:TELEWELL LLC
Entity type:Organization
Organization Name:TELEWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-291-5145
Mailing Address - Street 1:55 JONATHAN ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4801
Mailing Address - Country:US
Mailing Address - Phone:240-291-5145
Mailing Address - Fax:
Practice Address - Street 1:21400 W DIXIE HWY # 33180
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1144
Practice Address - Country:US
Practice Address - Phone:240-291-5145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033997671OtherNPI 2