MEDICARE: MID-ATLANTIC SURGICAL ASSOC.

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619977741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ATLANTIC SURGICAL ASSOC.

Provider Business Mailing Address
First Line	:	MID-ATLANTIC SURGICAL ASSOCIATES
Second Line	:	100 MADISON AVENUE
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960
Country	:	US
Telephone Number	:	973-971-7300
Fax Number	:	973-984-7019

Provider Business Practice Location Address
First Line	:	100 MADISON AVE
Second Line	:	GAGNON LEVEL C
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-6136
Country	:	US
Telephone Number	:	973-971-7300
Fax Number	:	973-984-7019

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DOUGLAS A IRVIN
Credential	:
Telephone Number	:	973-971-7300

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/21/2022

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