Mid Atlantic Medical Associates, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MID ATLANTIC MEDICAL ASSOCIATES, LLC

Doing business as

MAMA Primary Care

Practice address

10604 Rosehaven St
Fairfax, VA 22030-2825

Phone

(703) 627-9930

NPI assigned

Aug 27, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Shafeek Seddiq, ESQ.

Title

Member

Phone

(703) 677-6394

Specialties & licenses 5

Addresses

Other names 1

• MAMA Primary Care Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rajesh Puri, M.D., FAAP, FACPH

  • General Practice Physician
  • Arlington, VA
  • NPI 1194939033

  Phlebology

  NPD

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

{
    "created_epoch": "1724716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1609600303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10604 ROSEHAVEN ST",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302825",
            "telephone_number": "703-627-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10604 ROSEHAVEN ST",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302825",
            "telephone_number": "703-627-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID ATLANTIC MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-27",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "SEDDIQ",
        "authorized_official_first_name": "SHAFEEK",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "703-677-6394",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Phlebology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAMA Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dayna Michaelson
• Marissa Michalski, M.S., CCC-SLP
• Ernest Lee Michel, M.D.
• Michelle Booth, LCSW
• Nicole Michonski
• Mid Atlantic Pain Management, LLC
• Mid-South Home Care Services, LLC
• Mariana Sylvia Joanne Middelhof, M.D
• Laura Ann Middleton, CRNP
• Jessica Migler, LCSW

• Family Medicine Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.