=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790257855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID ATLANTIC PRIMARY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2018
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1322 BELMONT AVE STE 201
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-4593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-749-6833
-----------------------------------------------------
Fax | 410-749-5139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1322 BELMONT AVE STE 201
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-4593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-749-6833
-----------------------------------------------------
Fax | 410-749-5139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TRACI CHURCH
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 410-713-8804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------