Provider Demographics
NPI:1922287499
Name:MEDLANTIC HEALTHCARE GROUP, INC.
Entity Type:Organization
Organization Name:MEDLANTIC HEALTHCARE GROUP, INC.
Other - Org Name:EMC EMERGENCY PHYSICIANS - FRANKLIN SQUARE HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-355-0808
Mailing Address - Street 1:PO BOX 7206
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-7206
Mailing Address - Country:US
Mailing Address - Phone:800-355-0808
Mailing Address - Fax:610-834-2862
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-777-7068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD360102101Medicaid
MD1-LK61-EMOtherBLUE SHIELD
DC147747002OtherUS DEPARTMENT OF LABOR
MD360102102Medicaid
MD147747001OtherUS DEPARTMENT OF LABOR
MD360102100Medicaid
MD147747000OtherUS DEPARTMENT OF LABOR
DC027081800Medicaid
DCJ879OtherBLUE SHIELD
MD360102101Medicaid