Provider Demographics
NPI:1033309216
Name:MID ATLANTIC SLEEP CONSULTANTS LLC
Entity Type:Organization
Organization Name:MID ATLANTIC SLEEP CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASH
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEHNDIRATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-570-9700
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-0157
Mailing Address - Country:US
Mailing Address - Phone:301-570-9700
Mailing Address - Fax:301-260-2838
Practice Address - Street 1:19420 GOLF VISTA PLZ
Practice Address - Street 2:SUITE 110
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8265
Practice Address - Country:US
Practice Address - Phone:703-729-5537
Practice Address - Fax:301-260-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235675207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132210901Medicaid
G22958OtherUPIN
VAB713127OtherVA BUSINESS LICENSE
MD132210901Medicaid