Healthcare Provider Details

I. General information

NPI: 1356635429
Provider Name (Legal Business Name): MDICS REHABILITATIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 TIDEWATER COLONY DR SUITE 1A
ANNAPOLIS MD
21401-2101
US

IV. Provider business mailing address

2007 TIDEWATER COLONY DR SUITE 1A
ANNAPOLIS MD
21401-2101
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax: 443-949-0825
Mailing address:
  • Phone: 443-949-0814
  • Fax: 443-949-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0039037
License Number StateMD

VIII. Authorized Official

Name: DR. DOUG MITCHELL
Title or Position: MANAGING DIRECTOR
Credential: M.D.
Phone: 443-949-0814