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NPI Code Detail

MEDICARE: MIDDLETOWN VALLEY FAMILY MEDICINE, P.A.

MEDICARE: MIDDLETOWN VALLEY FAMILY MEDICINE, P.A.
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
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2H569OTHERMDBCBS GROUP NUMBER
3H931OTHERMDBCBS DC GROUP #

General Provider Information

NPI Number : 1700861259
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDDLETOWN VALLEY FAMILY MEDICINE, P.A.
Provider Business Mailing Address
First Line : 300 S CHURCH ST
Second Line :
City : MIDDLETOWN
State : MD
Zip : 21769-8043
Country : US
Telephone Number : 301-371-9000
Fax Number : 301-371-8905
Provider Business Practice Location Address
First Line : 300 S CHURCH ST
Second Line :
City : MIDDLETOWN
State : MD
Zip : 21769-8043
Country : US
Telephone Number : 301-371-9000
Fax Number : 301-371-8905
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : HEATHER M RAITHEL
Credential :
Telephone Number : 301-371-9000
Provider Enumeration Date : 12/07/2005
Last Update Date : 09/17/2009

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Practice Location Address:
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1508861568 — DR. MICHAEL STEPHEN RUDMAN M.D.
Practice Location Address:
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1982602462 — ADRIANA URIBE HOHL MD
Practice Location Address:
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1699723031 — DR. ANDREA D KALETA M.D.
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Practice Fax: 301-371-8905

Directions to “MIDDLETOWN VALLEY FAMILY MEDICINE, P.A. ” Practice Location

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