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Organization
MID ATLANTIC MEDICAL ASSOCIATES, LLC
Active
Organization
MID ATLANTIC MEDICAL ASSOCIATES, LLC
Active
Other names
MAMA Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAFEEK SEDDIQ ESQ. (MEMBER)
(703) 677-6394
Entity
Organization
Contact information
Practice address
10604 ROSEHAVEN ST, FAIRFAX, VA 22030-2825
(703) 627-9930
Mailing address
10604 ROSEHAVEN ST, FAIRFAX, VA 22030-2825
(703) 627-9930
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
NULL
202K00000X
Phlebology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
261QP2300X
Primary Care Clinic/Center
—
NULL
261QU0200X
Urgent Care Clinic/Center
—
NULL
Other
Enumeration date
08/27/2024
Last updated
08/27/2024
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