Provider Demographics
NPI:1083881973
Name:OB/GYN PHYSICIANS OF MID-ATLANTIC, PLLC
Entity Type:Organization
Organization Name:OB/GYN PHYSICIANS OF MID-ATLANTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:IGNATIUS
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-839-6300
Mailing Address - Street 1:6188 OXON HILL RD STE 603
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3152
Mailing Address - Country:US
Mailing Address - Phone:301-839-6300
Mailing Address - Fax:301-839-3002
Practice Address - Street 1:6188 OXON HILL RD STE 603
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3152
Practice Address - Country:US
Practice Address - Phone:301-839-6300
Practice Address - Fax:301-839-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-11
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38772207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD221881000Medicaid
MD221881000Medicaid
MDG02234O01Medicare PIN
MDG02234Medicare PIN