Provider Demographics
NPI:1083136220
Name:ATLANTIC MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:ATLANTIC MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAPAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-276-0568
Mailing Address - Street 1:10803 DAISY CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7207
Mailing Address - Country:US
Mailing Address - Phone:571-535-9352
Mailing Address - Fax:703-366-2761
Practice Address - Street 1:10803 DAISY CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-7207
Practice Address - Country:US
Practice Address - Phone:571-535-9352
Practice Address - Fax:703-366-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAN12-434343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)