Provider Demographics
NPI:1255161402
Name:MIDDLE RIVER HEALTHCARE, LLC
Entity type:Organization
Organization Name:MIDDLE RIVER HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JATU
Authorized Official - Middle Name:
Authorized Official - Last Name:KARPEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-779-0546
Mailing Address - Street 1:621 STEMMERS RUN RD STE B
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3386
Mailing Address - Country:US
Mailing Address - Phone:443-779-0546
Mailing Address - Fax:443-559-8360
Practice Address - Street 1:621 STEMMERS RUN RD STE B
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3386
Practice Address - Country:US
Practice Address - Phone:443-779-0546
Practice Address - Fax:443-559-8360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDDLE RIVER HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty