NPIMap

Organization Active NPI

Medexpress Primary Care Maryland, P.C.

  • General Practice Physician
  • Belcamp, MD
National Provider Identifier
1962049114
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MEDEXPRESS PRIMARY CARE MARYLAND, P.C.
Practice address
4622 Mercedes Dr
Belcamp, MD 21017-1223
Phone
(410) 297-2452
Fax
(410) 297-2453
NPI assigned
Dec 6, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

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

Authorized official

Name
Brett Gall
Title
Director Payor Contracting
Phone
(304) 225-2500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

4622 Mercedes Dr
Belcamp, MD 21017-1223

Mailing address

1001 Consol Energy Dr
Canonsburg, PA 15317-6506
Phone (304) 225-2500

Other names 1

  • Sephora - Belcamp Doing business as

National Provider Directory

National Provider Directory

Locations

4622 Mercedes Dr
Belcamp, MD 21017
Phone (410) 297-2452

NPI Registry JSON

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

{
    "created_epoch": "1575590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1962049114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 CONSOL ENERGY DR",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153176506",
            "telephone_number": "304-225-2500",
            "fax_number": "724-743-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4622 MERCEDES DR",
            "city": "BELCAMP",
            "state": "MD",
            "postal_code": "210171223",
            "telephone_number": "410-297-2452",
            "fax_number": "410-297-2453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDEXPRESS PRIMARY CARE MARYLAND, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-06",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "GALL",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "DIRECTOR PAYOR CONTRACTING",
        "authorized_official_telephone_number": "304-225-2500"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sephora - Belcamp",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sephora - Belcamp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belcamp, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.