# MDDE MEDICAL LLC

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

## Provider details

- **NPI number:** 1558876011
- **Authorized official:** CONSTANTINE MISOUL M.D. (CO-MANAGING MEMBER)
- **Authorized official phone:** (410) 933-5678

## Contact information

- **Practice address:** 1021 GILPIN AVENUE, WILMINGTON, DE 19806-3212
- **Practice address phone:** (410) 933-5678
- **Practice address fax:** (410) 238-7451
- **Mailing address:** 9601 PULASKI PARK DRIVE, SUITE 416, MIDDLE RIVER, MD 21220-1409
- **Mailing address phone:** (410) 933-5678
- **Mailing address fax:** (410) 238-7451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2017
- **Last updated:** 12/06/2017