Healthcare Provider Details

I. General information

NPI: 1811076581
Provider Name (Legal Business Name): MD MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8816 JERICHO CITY DR
LANDOVER MD
20785-4762
US

IV. Provider business mailing address

8816 JERICHO CITY DR
LANDOVER MD
20785-4762
US

V. Phone/Fax

Practice location:
  • Phone: 301-808-0341
  • Fax: 301-350-1398
Mailing address:
  • Phone: 301-808-0341
  • Fax: 301-350-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0040898
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberD0040898
License Number StateMD

VIII. Authorized Official

Name: MIRIAM MARTIN
Title or Position: OWNER
Credential:
Phone: 301-808-0341