Basic Information
| Provider Information | |||||||||
| NPI: | 1952322448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLBERY | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | ELISABETH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 WESTBARD CIR | ||||||||
| Address2: | #417 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208161401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019139143 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 803 RUSSELL AVE # 1 | ||||||||
| Address2: | SECURE MEDICAL CARE | ||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208793584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018690700 | ||||||||
| FaxNumber: | 3019479513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0046323 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | D0046323 | 01 | MD | PROFESSIONAL LICENSE | OTHER |