Provider Demographics
NPI:1437450293
Name:MID ATLANTIC PROSTHETICS AND ORTHOTICS NORTH
Entity Type:Organization
Organization Name:MID ATLANTIC PROSTHETICS AND ORTHOTICS NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BOCCPO
Authorized Official - Phone:302-824-2360
Mailing Address - Street 1:2604 KIRKWOOD HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4910
Mailing Address - Country:US
Mailing Address - Phone:302-824-2360
Mailing Address - Fax:302-691-7302
Practice Address - Street 1:2604 KIRKWOOD HWY
Practice Address - Street 2:SUITE C
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4910
Practice Address - Country:US
Practice Address - Phone:302-824-2360
Practice Address - Fax:302-691-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE10-999999-99335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier