Provider Demographics
NPI:1407810237
Name:MEAD MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:MEAD MEDICAL GROUP LLC
Other - Org Name:MEAD MEDICAL GROUP LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:CHIJIOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-474-4333
Mailing Address - Street 1:7333 HANOVER PKWY
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3655
Mailing Address - Country:US
Mailing Address - Phone:301-474-4333
Mailing Address - Fax:301-474-4335
Practice Address - Street 1:7333 HANOVER PKWY
Practice Address - Street 2:SUITE A & B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3655
Practice Address - Country:US
Practice Address - Phone:301-474-4333
Practice Address - Fax:301-474-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2110332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4765590001Medicare NSC