Healthcare Provider Details

I. General information

NPI: 1376503532
Provider Name (Legal Business Name): RENAL TREATMENT CENTERS - MID-ATLANTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9952 N MAIN ST BLDG #3
BERLIN MD
21811-1049
US

IV. Provider business mailing address

5200 VIRGINIA WAY L& C DEPARTMENT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 410-641-1321
  • Fax: 410-641-1538
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberE2520
License Number StateMD

VIII. Authorized Official

Name: SAMUEL T WEY
Title or Position: VP, LICENSURE & CERTIFICATION
Credential:
Phone: 615-341-6641