Provider Demographics
NPI:1225583123
Name:MID-ATLANTIC ADDICTION MEDICINE LLC
Entity type:Organization
Organization Name:MID-ATLANTIC ADDICTION MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDESHAHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-800-4466
Mailing Address - Street 1:1110 BENFIELD BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2639
Mailing Address - Country:US
Mailing Address - Phone:410-800-4466
Mailing Address - Fax:410-705-5024
Practice Address - Street 1:1110 BENFIELD BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2639
Practice Address - Country:US
Practice Address - Phone:410-800-4466
Practice Address - Fax:410-705-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder