Basic Information
Provider Information
NPI: 1841518495
EntityType: 2
ReplacementNPI:  
OrganizationName: MID ATLANTIC UROLOGY ASSOCIATES, LLC
LastName:  
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Credential:  
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Mailing Information
Address1: 7755 BELLE POINT DR
Address2:  
City: GREENBELT
State: MD
PostalCode: 207703316
CountryCode: US
TelephoneNumber: 3014413260
FaxNumber: 3014742389
Practice Location
Address1: 7809 BELLE POINT DR
Address2:  
City: GREENBELT
State: MD
PostalCode: 207703338
CountryCode: US
TelephoneNumber: 3014413260
FaxNumber: 3014742389
Other Information
ProviderEnumerationDate: 05/06/2010
LastUpdateDate: 05/06/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: EMANUEL
AuthorizedOfficialFirstName: ERIC
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: PHYSICIAN
AuthorizedOfficialTelephone: 3014413260
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332900000X  Y SuppliersNon-Pharmacy Dispensing Site 

No ID Information.


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