Provider Demographics
NPI:1932105756
Name:MID ATLANTIC PSYCHIATRIC PHYSICIANS
Entity Type:Organization
Organization Name:MID ATLANTIC PSYCHIATRIC PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-299-0582
Mailing Address - Street 1:822 MARIETTA AVE
Mailing Address - Street 2:STE 24
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3239
Mailing Address - Country:US
Mailing Address - Phone:717-299-0582
Mailing Address - Fax:717-394-8930
Practice Address - Street 1:822 MARIETTA AVE
Practice Address - Street 2:STE 24
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3239
Practice Address - Country:US
Practice Address - Phone:717-299-0582
Practice Address - Fax:717-394-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025752E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0073781550002Medicaid
PA025752-EOtherMEDICAL LICENSE #
PA013565Medicare ID - Type Unspecified
PA0073781550002Medicaid