| Brightwell Health Llc | |
|
7310 Ritchie Hwy Ste 516 Glen Burnie MD 21061-3099 | |
| (443) 221-2222 | |
| (844) 708-1264 |
| Full Name | Brightwell Health Llc |
|---|---|
| Speciality | Preventive Medicine |
| Location | 7310 Ritchie Hwy Ste 516, Glen Burnie, Maryland |
| Authorized Official Name and Position | Drew Fuller (OWNER) |
| Authorized Official Contact | 4436224317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brightwell Health Llc 7310 Ritchie Hwy Ste 516 Glen Burnie MD 21061-3099 Ph: (844) 387-7469 | Brightwell Health Llc 7310 Ritchie Hwy Ste 516 Glen Burnie MD 21061-3099 Ph: (443) 221-2222 |
| NPI Number | 1215515408 |
|---|---|
| Provider Enumeration Date | 03/30/2021 |
| Last Update Date | 05/28/2024 |
| Medicare PECOS PAC ID | 8224437397 |
|---|---|
| Medicare Enrollment ID | O20210521000216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215515408 | NPI | - | NPPES |
| D0053298 | Other | MD | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 2083A0300X | Preventive Medicine - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Drew Fuller |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1801808209 PECOS PAC ID: 9234047309 Enrollment ID: I20090701000526 |
| Provider Name | Shannon Tieman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326436254 PECOS PAC ID: 0547587776 Enrollment ID: I20150326001349 |
| Provider Name | Sofia A Arnold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639516933 PECOS PAC ID: 6406081140 Enrollment ID: I20160628002369 |
| Provider Name | Chad W Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295084713 PECOS PAC ID: 2365734738 Enrollment ID: I20160705000995 |
| Provider Name | Carliqua Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235724105 PECOS PAC ID: 3577971464 Enrollment ID: I20210414000012 |
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