Provider Demographics
NPI:1427055912
Name:TRC MID ATLANTIC,LLC
Entity type:Organization
Organization Name:TRC MID ATLANTIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-296-8888
Mailing Address - Street 1:7401 OSLER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7673
Mailing Address - Country:US
Mailing Address - Phone:410-296-8888
Mailing Address - Fax:410-296-6745
Practice Address - Street 1:2760 PINE GROVE RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5170
Practice Address - Country:US
Practice Address - Phone:717-741-5118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50023719OtherCAPITOL BLUE CROSS
PA396817Medicare Oscar/Certification