# PEDIATRIX MEDICAL GROUP OF THE MID-ATLANTIC PC

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

## Provider details

- **NPI number:** 1801643143
- **Authorized official:** NICHOLAS E. GLASER (ASSISTANT SECRETARY)
- **Authorized official phone:** (954) 384-0175

## Contact information

- **Practice address:** 11810 W MARKET PL STE 300, FULTON, MD 20759-2703
- **Practice address phone:** (240) 425-4824
- **Mailing address:** PO BOX 100445, ATLANTA, GA 30384-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | NULL | Yes |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2024
- **Last updated:** 11/04/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 287003703 | — | MD |