Organization
PEDIATRIX MEDICAL GROUP OF THE MID-ATLANTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS E. GLASER (ASSISTANT SECRETARY)
(954) 384-0175
Entity
Organization
Contact information
Practice address
11810 W MARKET PL STE 300, FULTON, MD 20759-2703
(240) 425-4824
Mailing address
PO BOX 100445, ATLANTA, GA 30384-0445
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287003703
—
MD
Enumeration date
05/03/2024
Last updated
11/04/2024
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