Healthcare Provider Details

I. General information

NPI: 1386898625
Provider Name (Legal Business Name): MDDC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 NASHUA CT SUITE H
BALTIMORE MD
21221-3133
US

IV. Provider business mailing address

3 NASHUA CT SUITE H
BALTIMORE MD
21221-3133
US

V. Phone/Fax

Practice location:
  • Phone: 410-933-5678
  • Fax: 410-933-3923
Mailing address:
  • Phone: 410-933-5678
  • Fax: 410-933-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE M. YALICH
Title or Position: PRESIDENT
Credential: D.C
Phone: 410-238-0140