Provider Demographics
NPI:1174380679
Name:MXJ HEALTHCARE LLC
Entity type:Organization
Organization Name:MXJ HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-414-9573
Mailing Address - Street 1:2368 FLAX TER
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4624
Mailing Address - Country:US
Mailing Address - Phone:443-414-9573
Mailing Address - Fax:
Practice Address - Street 1:3730 FALLS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1844
Practice Address - Country:US
Practice Address - Phone:443-414-9573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty