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General NPI Number Information
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NPI Number | 1437450293
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Entity Type | Organization
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Legal Business Name | MID ATLANTIC PROSTHETICS AND ORTHOTICS NORTH
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 2604 KIRKWOOD HWY SUITE C
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City | WILMINGTON
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State | DE
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Zip | 19805-4910
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Country | US
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Telephone | 302-824-2360
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Fax | 302-691-7302
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Provider Business Mailing Address
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Address Line | 2604 KIRKWOOD HWY SUITE C
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City | WILMINGTON
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State | DE
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Zip | 19805-4910
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Country | US
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Telephone | 302-824-2360
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Fax | 302-691-7302
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Authorized Official
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Title or Position | CERTIFIED PROSTHETIST ORTHOTIST
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Name | MR. BRIAN SMITH
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Credential | BOCCPO
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Telephone | 302-824-2360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 10-999999-99
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License Number State | DE
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