Provider Demographics
NPI:1376687202
Name:MEDIQUEST, LLC
Entity Type:Organization
Organization Name:MEDIQUEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:NELMA
Authorized Official - Last Name:MAHIPAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-655-8900
Mailing Address - Street 1:5310 OLD COURT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5243
Mailing Address - Country:US
Mailing Address - Phone:410-655-8900
Mailing Address - Fax:410-655-0498
Practice Address - Street 1:5310 OLD COURT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5243
Practice Address - Country:US
Practice Address - Phone:410-655-8900
Practice Address - Fax:410-655-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD42630OtherMAMSI
MD4393773OtherAETNA PPO
MD354462OtherAETNA HMO
MD7491554OtherAETNA
MD523886OtherMAMSI ENDOCRINOLOGY
MD666069OtherCAN GROUP
MD101943OtherPRIORITY PARTNERS AND EHP
MD423886OtherMAMSI INTERNAL MEDICINE
MD354462OtherAETNA HMO
MD=========OtherNATIONAL PROVIDER NETWORK
MD910MMedicare ID - Type UnspecifiedMEDICARE