MEDICARE: MID-ATLANTIC EPILEPSY & SLEEP CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1134953409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ATLANTIC EPILEPSY & SLEEP CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 782438
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-2438
Country	:	US
Telephone Number	:	301-530-9745
Fax Number	:	301-530-0046

Provider Business Practice Location Address
First Line	:	1715 N GEORGE MASON DR STE 107
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-3642
Country	:	US
Telephone Number	:	301-530-9744
Fax Number	:	301-530-0046

Authorized Official
Title or Position	:	DIRECTOR/PHYSICIAN
Name	:	MARCELO E LANCMAN
Credential	:	MD
Telephone Number	:	914-428-3651

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	08/29/2024

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