Provider Demographics
NPI:1396261087
Name:ABSOLUTECARE OF MD2, LLC
Entity type:Organization
Organization Name:ABSOLUTECARE OF MD2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-738-0225
Mailing Address - Street 1:10175 LITTLE PATUXENT PKWY STE 800
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7501 GREENWAY CENTER DRIVE
Practice Address - Street 2:STE 600
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-6704
Practice Address - Country:US
Practice Address - Phone:301-579-3465
Practice Address - Fax:404-231-5977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD797705100Medicaid