MAFOT & ASSOCIATES MEDICAL SERVICES LLC NPI 1104248541

NPI Information

  • NPI: 1104248541
  • Provider Name: MAFOT & ASSOCIATES MEDICAL SERVICES LLC
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • CLIA Number: 21D2159075
  • Address: 1403 MADISON PARK DR STE 200
    GLEN BURNIE, MD
    ZIP 21061
  • Phone: (410) 487-6902

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NPI Details

MAFOT & ASSOCIATES MEDICAL SERVICES LLC is a general practice in Glen Burnie, MD. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee MAFOT & ASSOCIATES MEDICAL SERVICES LLC NPI is 1104248541. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1403 MADISON PARK DR STE 200
GLEN BURNIE, MD
ZIP 21061-427
Phone: (410) 487-6902
Fax: (410) 487-6982

The provider's authorized official is Dagobert Simo .
The authorized official title is Director and has the following contact phone number (240) 432-1924.

The CLIA number assigned to this NPI record is 21D2159075 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/18/2014 and was last updated on 8/31/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeD0073466MARYLANDYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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