Provider Demographics
NPI:1205960986
Name:MED TEL INTERNATIONAL CORPORATION
Entity type:Organization
Organization Name:MED TEL INTERNATIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-873-9850
Mailing Address - Street 1:1430 SPRING HILL RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3000
Mailing Address - Country:US
Mailing Address - Phone:703-287-4189
Mailing Address - Fax:703-448-8180
Practice Address - Street 1:1820 SWEETBAY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1428
Practice Address - Country:US
Practice Address - Phone:410-546-3390
Practice Address - Fax:410-546-6136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED TEL INTERNAITONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM269R261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD192MMedicare PIN