MEDICARE: MID-ATLANTIC ENT, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician
3	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1932951670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ATLANTIC ENT, LLC

Provider Business Mailing Address
First Line	:	600 RIDGELY AVE STE 110
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-1082
Country	:	US
Telephone Number	:	410-573-9191
Fax Number	:	410-573-5910

Provider Business Practice Location Address
First Line	:	621 RIDGELY AVE STE 401
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-1099
Country	:	US
Telephone Number	:	410-573-9191
Fax Number	:	410-573-5910

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	LEE ALLAN KLEIMAN
Credential	:	MD
Telephone Number	:	410-573-9191

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	06/01/2026

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Directions to “MID-ATLANTIC ENT, LLC ” Practice Location

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