Healthcare Provider Details

I. General information

NPI: 1699686048
Provider Name (Legal Business Name): M MEDICAL GROUP - S PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 VADEN DR
GRETNA VA
24557-4157
US

IV. Provider business mailing address

6 E EAGER ST
BALTIMORE MD
21202-2506
US

V. Phone/Fax

Practice location:
  • Phone: 434-656-1206
  • Fax:
Mailing address:
  • Phone: 248-343-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY DESANTIS
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 248-343-0358