Provider Demographics
NPI:1407970601
Name:MARYLAND PHYSICIANS ASSOCIATES
Entity Type:Organization
Organization Name:MARYLAND PHYSICIANS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELENCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-486-2298
Mailing Address - Street 1:6615 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 205A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-2686
Mailing Address - Country:US
Mailing Address - Phone:410-486-2298
Mailing Address - Fax:410-358-6551
Practice Address - Street 1:6615 REISTERSTOWN RD
Practice Address - Street 2:SUITE 205A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2686
Practice Address - Country:US
Practice Address - Phone:410-486-2298
Practice Address - Fax:410-358-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1568545432OtherNAZEMI, NPI
MD36713002Medicaid
MD1992852933OtherKOZACHUK NPI
MD1952406043OtherGARIN NPI
MD1265538623OtherVENTURA NPI
MD1619073111OtherMOLFINO NPI
MDW4920000OtherBCHOICE MD VENTURA
MDW4920000OtherBCHOICE MD VENTURA