DVA HEALTHCARE OF MARYLAND LLC NPI 1023078466

NPI Information

DVA HEALTHCARE OF MARYLAND LLC is an end-stage renal disease (esrd) treatment clinic center in Frederick, MD. DVA HEALTHCARE OF MARYLAND LLC NPI is 1023078466. The provider is registered as an organization entity type.
The provider Is Doing Business As Frederick Dialysis.

The provider's business location address is:

140 THOMAS JOHNSON DR
STE 100
FREDERICK, MD
ZIP 21702-475
Phone: (301) 695-0900
Fax: (301) 695-2808

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 21D0859435 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/27/2006 and was last updated on 11/30/2023.

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:

Other Identifiers

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

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