Provider Demographics
NPI:1700194206
Name:EMERGENCY MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:EMERGENCY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-493-4443
Mailing Address - Street 1:20010 CENTURY BLVD., SUITE 200
Mailing Address - Street 2:EMERGENCY MEDICINE ASSOCIATES
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-686-2330
Practice Address - Street 1:701 EAST CHARLES ST.
Practice Address - Street 2:CIVISTA MEDICAL CENTER
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:310-609-4160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD905321200Medicaid
MD568LMedicare PIN