MEDICARE: MID-ATLANTIC PROSTHETICS-EAST, 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	335E00000X	Prosthetic/Orthotic Supplier

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073712766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ATLANTIC PROSTHETICS-EAST, LLC

Provider Business Mailing Address
First Line	:	1023 N CHARLES ST STE R3N
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-5410
Country	:	US
Telephone Number	:	240-401-8063
Fax Number	:	667-210-2167

Provider Business Practice Location Address
First Line	:	1023 N CHARLES ST STE R3N
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-5410
Country	:	US
Telephone Number	:	240-401-8063
Fax Number	:	667-210-2167

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD LONGO
Credential	:
Telephone Number	:	301-987-9113

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	06/13/2023

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Directions to “MID-ATLANTIC PROSTHETICS-EAST, LLC ” Practice Location

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