Provider Demographics
NPI:1255546263
Name:JEAN ALBERT MIDY MD PA
Entity type:Organization
Organization Name:JEAN ALBERT MIDY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:MIDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:410-997-9255
Mailing Address - Street 1:11441 HIGH HAY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1027
Mailing Address - Country:US
Mailing Address - Phone:410-997-9255
Mailing Address - Fax:410-298-8225
Practice Address - Street 1:1940 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2245
Practice Address - Country:US
Practice Address - Phone:410-298-8223
Practice Address - Fax:410-298-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00267202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB66845Medicare UPIN
MD6032Medicare PIN