Provider Demographics
NPI:1811076581
Name:MD MEDICAL INC
Entity type:Organization
Organization Name:MD MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-808-0341
Mailing Address - Street 1:8816 JERICHO CITY DR
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4762
Mailing Address - Country:US
Mailing Address - Phone:301-808-0341
Mailing Address - Fax:301-350-1983
Practice Address - Street 1:8816 JERICHO CITY DR
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4762
Practice Address - Country:US
Practice Address - Phone:301-808-0341
Practice Address - Fax:301-350-1398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040898332900000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133130OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2133130OtherOTHER ID NUMBER-COMMERCIAL NUMBER