Provider Demographics
NPI:1083766646
Name:ATLANTIC MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ATLANTIC MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-356-5761
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-0295
Mailing Address - Country:US
Mailing Address - Phone:410-356-5761
Mailing Address - Fax:
Practice Address - Street 1:10952 BASKERVILLE RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6406
Practice Address - Country:US
Practice Address - Phone:410-356-5761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD193773207R00000X
MD20011208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG71212Medicare UPIN
MD888MMedicare ID - Type UnspecifiedIDENTIFICATION NUMBER