Provider Demographics
NPI:1780209866
Name:APS CORELIFE LLC
Entity Type:Organization
Organization Name:APS CORELIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-315-3030
Mailing Address - Street 1:820 W DIAMOND AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1469
Mailing Address - Country:US
Mailing Address - Phone:301-315-3102
Mailing Address - Fax:
Practice Address - Street 1:579 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3809
Practice Address - Country:US
Practice Address - Phone:410-975-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty