Healthcare Provider Details

I. General information

NPI: 1790768380
Provider Name (Legal Business Name): UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KING FARM BLVD SUITE 800
ROCKVILLE MD
20850
US

IV. Provider business mailing address

800 KING FARM
ROCKVILLE MD
20850-5979
US

V. Phone/Fax

Practice location:
  • Phone: 571-455-4605
  • Fax: 703-286-3994
Mailing address:
  • Phone: 703-462-7417
  • Fax: 703-286-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number10153
License Number StateVA

VIII. Authorized Official

Name: MR. JAMES E LOVE III
Title or Position: CHIEF FINANCIAL OFFICER (UHC OF MID
Credential:
Phone: 215-832-4501