Provider Demographics
NPI:1477503118
Name:MEDSTAR PHYSICIAN PARTNERS, INC
Entity Type:Organization
Organization Name:MEDSTAR PHYSICIAN PARTNERS, INC
Other - Org Name:MEDLANTIC HEALTHCARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-725-8762
Mailing Address - Street 1:9600 PULASKI PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1400
Mailing Address - Country:US
Mailing Address - Phone:410-574-3000
Mailing Address - Fax:410-574-2261
Practice Address - Street 1:9600 PULASKI PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-1400
Practice Address - Country:US
Practice Address - Phone:410-574-3000
Practice Address - Fax:410-574-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035476700Medicaid
DB8990OtherRAILROAD MEDICARE
MD414263200Medicaid
7099OtherCAREFIRST DC
B016OtherCAREFIRST DC
KF60MEOtherCAREFIRST MD
4300OtherCAREFIRST DC
6003OtherCAREFIRST DC
0176OtherCAREFIRST DC
1777OtherCAREFIRST DC
J484OtherCAREFIRST DC
DC035476700Medicaid