# MID ATLANTIC MEDICAL ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MAMA Primary Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609600303
- **Authorized official:** MR. SHAFEEK SEDDIQ ESQ. (MEMBER)
- **Authorized official phone:** (703) 677-6394

## Contact information

- **Practice address:** 10604 ROSEHAVEN ST, FAIRFAX, VA 22030-2825
- **Practice address phone:** (703) 627-9930
- **Mailing address:** 10604 ROSEHAVEN ST, FAIRFAX, VA 22030-2825
- **Mailing address phone:** (703) 627-9930

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | — | NULL | — |
| 202K00000X | Phlebology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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