Provider Demographics
NPI:1174632376
Name:ATLANTIC PHYSICIAN SERVICES OF MARYLAND, PC
Entity Type:Organization
Organization Name:ATLANTIC PHYSICIAN SERVICES OF MARYLAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-686-4300
Mailing Address - Street 1:PO BOX 8526
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-8526
Mailing Address - Country:US
Mailing Address - Phone:856-686-4316
Mailing Address - Fax:856-848-1431
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:410-532-4040
Practice Address - Fax:410-532-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCG0402OtherRR MEDICARE
MDCG0402OtherRR MEDICARE