Basic Information
| Provider Information | |||||||||
| NPI: | 1730129594 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC PHYSICIAN SERVICES OF MARYLAND, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 634994 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566864316 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 N CLAYTON ST. | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198050000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566864316 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 12/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | FLOWERS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8568483817 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363A00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | W7Z571 | 01 | NY | NY EMPIRE MEDICARE | OTHER | 1730129594 | 05 | DE | MEDICAID |