1831205293 NPI number — POTOMIC MEDICAL SUPPLIES, INC

Table of content: (NPI 1831205293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831205293 NPI number — POTOMIC MEDICAL SUPPLIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POTOMIC MEDICAL SUPPLIES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831205293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8957 EDMONSTON RD
Provider Second Line Business Mailing Address:
SUITE Q
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-1005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-270-0612
Provider Business Mailing Address Fax Number:
301-270-1487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8957 EDMONSTON ROAD
Provider Second Line Business Practice Location Address:
SUITE Q
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-270-0612
Provider Business Practice Location Address Fax Number:
301-270-1487
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDUFF
Authorized Official First Name:
DOMINIC
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
301-270-0612

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 406117900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com