Provider Demographics
NPI:1306829320
Name:MIDDLETON, JOHN WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WAYNE
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 HALTER RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-1901
Mailing Address - Country:US
Mailing Address - Phone:410-857-8202
Mailing Address - Fax:
Practice Address - Street 1:688C POOLE RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6003
Practice Address - Country:US
Practice Address - Phone:410-857-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD337321500Medicaid
MD337321500Medicaid
MDD75277Medicare UPIN