Provider Demographics
NPI:1356635429
Name:MDICS REHABILITATIVE SERVICES
Entity Type:Organization
Organization Name:MDICS REHABILITATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-949-0814
Mailing Address - Street 1:2007 TIDEWATER COLONY DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2101
Mailing Address - Country:US
Mailing Address - Phone:443-949-0814
Mailing Address - Fax:443-949-0825
Practice Address - Street 1:2007 TIDEWATER COLONY DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2101
Practice Address - Country:US
Practice Address - Phone:443-949-0814
Practice Address - Fax:443-949-0825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDICS MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039037208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty