Provider Demographics
NPI:1942250691
Name:MEDLANTIC HEALTH GROUP
Entity Type:Organization
Organization Name:MEDLANTIC HEALTH GROUP
Other - Org Name:MEDSTAR PHYSICIAN PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:NICOLA
Authorized Official - Last Name:LLEWELLYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-546-4504
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-897-5001
Mailing Address - Fax:301-897-5193
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-897-5001
Practice Address - Fax:301-897-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory