Provider Demographics
NPI:1568507945
Name:MED-SURG CARE PC
Entity Type:Organization
Organization Name:MED-SURG CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-870-3200
Mailing Address - Street 1:6620 CRAIN HIGHWAY
Mailing Address - Street 2:SUITE104
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646
Mailing Address - Country:US
Mailing Address - Phone:301-934-2299
Mailing Address - Fax:301-392-2119
Practice Address - Street 1:6620 CRAIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-934-2299
Practice Address - Fax:301-392-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH499Medicare PIN