Provider Demographics
NPI:1669604930
Name:MEDSTAR FAMILY CHOICE, INC
Entity type:Organization
Organization Name:MEDSTAR FAMILY CHOICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-933-3013
Mailing Address - Street 1:8094 SANDPIPER CIR
Mailing Address - Street 2:SUITE O
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4907
Mailing Address - Country:US
Mailing Address - Phone:410-933-3014
Mailing Address - Fax:410-933-3019
Practice Address - Street 1:8094 SANDPIPER CIR
Practice Address - Street 2:SUITE O
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4907
Practice Address - Country:US
Practice Address - Phone:410-933-3014
Practice Address - Fax:410-933-3019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSTAR HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization