MEDICARE: MID ATLANTIC MEDICAL P.C.

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	174400000X	Specialist	219013-1	NY

General Provider Information

NPI Number	:	1376782862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID ATLANTIC MEDICAL P.C.

Provider Business Mailing Address
First Line	:	436 FORT WASHINGTON AVE
Second Line	:	SUITE 1H
City	:	NEW YORK
State	:	NY
Zip	:	10033-3507
Country	:	US
Telephone Number	:	212-781-4720
Fax Number	:	212-923-9585

Provider Business Practice Location Address
First Line	:	436 FORT WASHINGTON AVE
Second Line	:	SUITE 1H
City	:	NEW YORK
State	:	NY
Zip	:	10033-3507
Country	:	US
Telephone Number	:	212-781-4720
Fax Number	:	212-923-9585

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LUBA KARLIN
Credential	:	M.D.
Telephone Number	:	212-781-4720

Provider Enumeration Date	:	02/07/2009
Last Update Date	:	02/07/2009

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