1053848044 NPI number — MID ATLANTIC BIO SOLUTIONS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053848044 NPI number — MID ATLANTIC BIO SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID ATLANTIC BIO SOLUTIONS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053848044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9000 VIRGINIA MANOR RD STE 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20705-4214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-303-9923
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 VIRGINIA MANOR RD STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20705-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-496-2885
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BLOCKSTON
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
410-303-9923

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0 . This is a "OUT OF NETWORK PROVIDER .." identifier . This identifiers is of the category "OTHER".




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