Healthcare Provider Details

I. General information

NPI: 1770175978
Provider Name (Legal Business Name): MID-ATLANTIC ENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIDGELY AVE STE 110
ANNAPOLIS MD
21401-1082
US

IV. Provider business mailing address

600 RIDGELY AVE STE 110
ANNAPOLIS MD
21401-1082
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-9191
  • Fax: 410-573-5910
Mailing address:
  • Phone: 410-573-9191
  • Fax: 410-573-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEE ALLAN KLEIMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 410-573-9191