Provider Demographics
NPI:1346488343
Name:MID ATLANTIC EYE, LLC
Entity Type:Organization
Organization Name:MID ATLANTIC EYE, LLC
Other - Org Name:MID ATLANTIC EYE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAMANIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:410-616-9952
Mailing Address - Street 1:40 YORK RD STE 500
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5243
Mailing Address - Country:US
Mailing Address - Phone:410-616-9952
Mailing Address - Fax:443-927-7515
Practice Address - Street 1:40 YORK RD STE 500
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5243
Practice Address - Country:US
Practice Address - Phone:410-616-9952
Practice Address - Fax:443-927-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067362207W00000X
261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD025039200Medicaid
PA1016496560002Medicaid
PA1016496560002Medicaid