Provider Demographics
NPI:1407180326
Name:MID ATLANTIC PHYSICIAN ASSISTANT SERVICES, P.C.
Entity type:Organization
Organization Name:MID ATLANTIC PHYSICIAN ASSISTANT SERVICES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:804-972-3379
Mailing Address - Street 1:4740 SADLER GREEN PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6162
Mailing Address - Country:US
Mailing Address - Phone:804-972-3379
Mailing Address - Fax:804-935-1367
Practice Address - Street 1:4740 SADLER GREEN PL
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6162
Practice Address - Country:US
Practice Address - Phone:804-972-3379
Practice Address - Fax:804-935-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001211363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty