Provider Demographics
NPI:1528248655
Name:MID ATLANTIC SURGICAL LLC
Entity type:Organization
Organization Name:MID ATLANTIC SURGICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUSCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-652-6050
Mailing Address - Street 1:PO BOX 8157
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-8157
Mailing Address - Country:US
Mailing Address - Phone:302-652-6050
Mailing Address - Fax:302-652-6053
Practice Address - Street 1:1015 W BALTIMORE PIKE
Practice Address - Street 2:MOB SUITE 201
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9459
Practice Address - Country:US
Practice Address - Phone:302-652-6050
Practice Address - Fax:302-652-6053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007648708OtherAETNA PIN
PA1012770780002Medicaid
PA087999Medicare PIN