Provider Demographics
NPI:1831391549
Name:MAINLAND FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:MAINLAND FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-926-2560
Mailing Address - Street 1:235 SHORE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2631
Mailing Address - Country:US
Mailing Address - Phone:609-926-2560
Mailing Address - Fax:609-926-4177
Practice Address - Street 1:235 SHORE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2631
Practice Address - Country:US
Practice Address - Phone:609-926-2560
Practice Address - Fax:609-926-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
087210Medicare ID - Type Unspecified