Provider Demographics
NPI:1508459199
Name:MID ATLANTIC MEDICINE LLC
Entity Type:Organization
Organization Name:MID ATLANTIC MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP IPM
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:PO BOX 746004
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6004
Mailing Address - Country:US
Mailing Address - Phone:484-250-8475
Mailing Address - Fax:484-913-7587
Practice Address - Street 1:2228 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5700
Practice Address - Country:US
Practice Address - Phone:202-964-4727
Practice Address - Fax:202-902-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care