HAVANNA DIALYSIS LLC NPI 1013433713

NPI Information

  • NPI: 1013433713
  • Provider Name: HAVANNA DIALYSIS LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • :
  • CLIA Number: 21D2136936
  • Address: 202 PERRY PKWY STE 3
    GAITHERSBURG, MD
    ZIP 20877
  • Phone: (301) 987-0912

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NPI Details

HAVANNA DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Gaithersburg, MD. HAVANNA DIALYSIS LLC NPI is 1013433713. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

202 PERRY PKWY STE 3
GAITHERSBURG, MD
ZIP 20877-172
Phone: (301) 987-0912
Fax: (301) 947-6115

The provider's authorized official is Samuel T Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 21D2136936 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/15/2017 and was last updated on 11/17/2025.

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
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentMARYLANDYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
16600131MEDICAIDMARYLAND

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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