Organization Name: | DVA HEALTHCARE OF MARYLAND INC |
NPI Number: | 1023078466 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES K. HILGER (CHIEF ACCOUNTING OFFICER) |
Mailing Address: | 140 Thomas Johnson Dr Ste100 Frederick |
State: | MD US |
Postal Code: | 217024475 |
Phone Number: | 3016950900 |
Fax Number: | 3016952808 |
NPI Enumeration Date: | 03/27/2006 |
NPI Last Update Date: | 09/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | E2598 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |