Provider Demographics
NPI:1134899784
Name:ATLANTIC RENAL CARE LLC
Entity type:Organization
Organization Name:ATLANTIC RENAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-710-2240
Mailing Address - Street 1:27659 ARABIAN DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1830
Mailing Address - Country:US
Mailing Address - Phone:757-710-2240
Mailing Address - Fax:
Practice Address - Street 1:606 S SCHUMAKER DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-8708
Practice Address - Country:US
Practice Address - Phone:757-710-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty