Healthcare Provider Details

I. General information

NPI: 1538462288
Provider Name (Legal Business Name): ATLANTIC REHABILITATION CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FREDERICK RD SUITE 200
BALTIMORE MD
21228-4645
US

IV. Provider business mailing address

6030 DAYBREAK CIR SUITE A150/337
CLARKSVILLE MD
21029-1642
US

V. Phone/Fax

Practice location:
  • Phone: 410-455-9690
  • Fax: 410-764-0947
Mailing address:
  • Phone: 410-455-9690
  • Fax: 410-764-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S KORANGY
Title or Position: CFO
Credential:
Phone: 410-455-9690