Provider Demographics
NPI:1447598602
Name:ARZADON FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:ARZADON FAMILY PRACTICE PA
Other - Org Name:VILLAGE SQ. FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARZADON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-523-0601
Mailing Address - Street 1:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-5340
Mailing Address - Country:US
Mailing Address - Phone:443-523-0601
Mailing Address - Fax:410-973-1453
Practice Address - Street 1:11042 NICHOLAS LN
Practice Address - Street 2:UNIT B102
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3299
Practice Address - Country:US
Practice Address - Phone:443-523-0601
Practice Address - Fax:410-973-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty