Healthcare Provider Details

I. General information

NPI: 1225588569
Provider Name (Legal Business Name): MID-ATLANTIC INSTITUTE OF VENOUS AND LYMPHATIC MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 E PULASKI HWY STE 1B
ELKTON MD
21921-6057
US

IV. Provider business mailing address

677 E PULASKI HWY STE 1B
ELKTON MD
21921-6057
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-0215
  • Fax: 443-593-3725
Mailing address:
  • Phone: 410-398-0215
  • Fax: 443-593-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: MOHAMMAD BASIT AFZAL
Title or Position: PROVIDER
Credential: MD, RPVI
Phone: 410-398-0215