MEDICARE: MID ATLANTIC PRIMARY CARE

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	261QP2300X	Primary Care Clinic/Center
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1790257855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID ATLANTIC PRIMARY CARE

Provider Business Mailing Address
First Line	:	1322 BELMONT AVE STE 201
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21804-4593
Country	:	US
Telephone Number	:	410-749-6833
Fax Number	:	410-749-5139

Provider Business Practice Location Address
First Line	:	1322 BELMONT AVE STE 201
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21804-4593
Country	:	US
Telephone Number	:	410-749-6833
Fax Number	:	410-749-5139

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TRACI CHURCH
Credential	:	DNP
Telephone Number	:	410-713-8804

Provider Enumeration Date	:	12/28/2018
Last Update Date	:	12/17/2025

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Directions to “MID ATLANTIC PRIMARY CARE ” Practice Location

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