# MID ATLANTIC SPINE & ORTHOPAEDICS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396949848
- **Authorized official:** RANDY F DAVIS M.D. (OWNER)
- **Authorized official phone:** (410) 553-8290

## Contact information

- **Practice address:** 305 HOSPITAL DR, SUITE 303, GLEN BURNIE, MD 21061-5805
- **Practice address phone:** (410) 553-8290
- **Mailing address:** 305 HOSPITAL DR, SUITE 303, GLEN BURNIE, MD 21061-5805
- **Mailing address phone:** (410) 553-8290

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | D0024332 | MD | Yes |

## Other

- **Enumeration date:** 06/11/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | K894 | CAPITAL BLUE CROSS | MD |