Provider Demographics
NPI:1790257855
Name:MID ATLANTIC PRIMARY CARE
Entity type:Organization
Organization Name:MID ATLANTIC PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:410-713-8804
Mailing Address - Street 1:1322 BELMONT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4593
Mailing Address - Country:US
Mailing Address - Phone:410-749-6833
Mailing Address - Fax:410-749-5139
Practice Address - Street 1:1322 BELMONT AVE STE 201
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4593
Practice Address - Country:US
Practice Address - Phone:410-749-6833
Practice Address - Fax:410-749-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty