Healthcare Provider Details

I. General information

NPI: 1033418850
Provider Name (Legal Business Name): MID-ATLANTIC MEDICAL SERVICES,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W 57TH ST SUITE #1107
NEW YORK NY
10019-2802
US

IV. Provider business mailing address

4702 W HIGHWAY 74
MONROE NC
28110-8453
US

V. Phone/Fax

Practice location:
  • Phone: 212-874-3384
  • Fax: 212-874-0031
Mailing address:
  • Phone: 212-874-3384
  • Fax: 212-874-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number170169-1
License Number StateNY

VIII. Authorized Official

Name: DR. JAMES PALMA
Title or Position: OWNER
Credential: MD
Phone: 212-874-3384