Healthcare Provider Details

I. General information

NPI: 1225644701
Provider Name (Legal Business Name): MIRACLE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 LANDOVER RD STE 3
CHEVERLY MD
20785-1145
US

IV. Provider business mailing address

6005 LANDOVER RD STE 5
CHEVERLY MD
20785-1145
US

V. Phone/Fax

Practice location:
  • Phone: 240-603-0502
  • Fax: 443-790-9236
Mailing address:
  • Phone: 240-687-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY ALTAMARIA MAPP
Title or Position: PHYSICINE
Credential: DO
Phone: 240-603-0502