Provider Demographics
NPI:1225316011
Name:MID-ATLANTIC MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MID-ATLANTIC MEDICAL ASSOCIATES, LLC
Other - Org Name:ROBERT PATEL MD, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-726-2077
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-0080
Mailing Address - Country:US
Mailing Address - Phone:732-297-5302
Mailing Address - Fax:
Practice Address - Street 1:1 BEEKMAN RD
Practice Address - Street 2:SUITE 5
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1459
Practice Address - Country:US
Practice Address - Phone:732-297-5302
Practice Address - Fax:732-694-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089406Medicare PIN