Provider Demographics
NPI:1225337272
Name:MID ATLANTIC MEDICAL ASSOC INC
Entity type:Organization
Organization Name:MID ATLANTIC MEDICAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-313-7911
Mailing Address - Street 1:33 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2163
Mailing Address - Country:US
Mailing Address - Phone:856-313-7911
Mailing Address - Fax:
Practice Address - Street 1:120 CARNIE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4520
Practice Address - Country:US
Practice Address - Phone:856-751-7799
Practice Address - Fax:856-751-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08725900208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty