MEDICARE: ATLANTIC MEDICAL ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013488188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC MEDICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	6717 PARK HEIGHTS AVE LOWR LEVEL
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-2443
Country	:	US
Telephone Number	:	410-764-6764
Fax Number	:	410-363-1272

Provider Business Practice Location Address
First Line	:	6717 PARK HEIGHTS AVE LOWR LEVEL
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-2443
Country	:	US
Telephone Number	:	410-764-6764
Fax Number	:	410-363-1272

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. RICHARD COHEN
Credential	:
Telephone Number	:	410-469-9837

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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