Provider Demographics
NPI:1821113846
Name:MDXL, LLC
Entity Type:Organization
Organization Name:MDXL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:703-256-8744
Mailing Address - Street 1:6850 VERSAR CTR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-4175
Mailing Address - Country:US
Mailing Address - Phone:703-256-8744
Mailing Address - Fax:703-256-8774
Practice Address - Street 1:6850 VERSAR CTR
Practice Address - Street 2:SUITE 302
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-4175
Practice Address - Country:US
Practice Address - Phone:703-256-8744
Practice Address - Fax:703-256-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization