Provider Demographics
NPI:1508350141
Name:DELMARVA CAPITAL, LLC
Entity Type:Organization
Organization Name:DELMARVA CAPITAL, LLC
Other - Org Name:ATLANTIC MEDICAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-469-9837
Mailing Address - Street 1:5717 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3707
Mailing Address - Country:US
Mailing Address - Phone:410-469-9837
Mailing Address - Fax:443-288-4036
Practice Address - Street 1:5717 FALLS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-469-9837
Practice Address - Fax:443-288-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDZ1680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD272901600Medicaid