Mid-Atlantic Prosthetics-East, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

MID-ATLANTIC PROSTHETICS-EAST, LLC

Practice address

1023 N Charles St Ste R3N
Baltimore, MD 21201-5410

Phone

(240) 401-8063

Fax

(667) 210-2167

NPI assigned

Jul 13, 2007

Last updated

Jun 15, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Longo, CPO

Title

Owner

Phone

(703) 447-7565

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Lawson Medical LLC

  • Durable Medical Equipment & Medical Supplies
  • Virginia Beach, VA
  • NPI 1841281821

  Member Of

  NPD member

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alex Richard Ford, BOCCPO

  • Prosthetist
  • Fort Mill, SC
  • NPI 1891032587

  Orthotist

  NPD
• Randy M Fox, CFO

  • Orthotic Fitter
  • Gastonia, NC
  • NPI 1457878209
  NPD
• Theresa Walker Utt, CMF

  • Mastectomy Fitter
  • Gastonia, NC
  • NPI 1477975035
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1073712766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 N CHARLES ST STE R3N",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015410",
            "telephone_number": "240-401-8063",
            "fax_number": "667-210-2167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 N CHARLES ST STE R3N",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015410",
            "telephone_number": "240-401-8063",
            "fax_number": "667-210-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-ATLANTIC PROSTHETICS-EAST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "LONGO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-447-7565",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040028800",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "416699000",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5412838 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mid-Atlantic Sports Therapy & Rehabilitation, LLC
• Mid-Atlantic Treatment Services, Inc (Crossroads Centers)
• Mid-Atlantic Ventures, Inc (Westside Pharmacy & Wellness Ctr)

• Prosthetic/Orthotic Supplier in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Prosthetic/Orthotic Supplier in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.