Provider Demographics
NPI:1225588569
Name:MID-ATLANTIC INSTITUTE OF VENOUS AND LYMPHATIC MEDICINE LLC
Entity Type:Organization
Organization Name:MID-ATLANTIC INSTITUTE OF VENOUS AND LYMPHATIC MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:BASIT
Authorized Official - Last Name:AFZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, RPVI
Authorized Official - Phone:410-398-0215
Mailing Address - Street 1:677 E PULASKI HWY STE 1B
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6057
Mailing Address - Country:US
Mailing Address - Phone:410-398-0215
Mailing Address - Fax:443-593-3725
Practice Address - Street 1:677 E PULASKI HWY STE 1B
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6057
Practice Address - Country:US
Practice Address - Phone:410-398-0215
Practice Address - Fax:443-593-3725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
202K00000X
MD207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty