Provider Demographics
NPI:1093965618
Name:MORGAN CD LOTT GROUP I
Entity Type:Organization
Organization Name:MORGAN CD LOTT GROUP I
Other - Org Name:LOTT CHERYL D LOTT I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EXECUTIVE OFFICER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-390-3128
Mailing Address - Street 1:1809 PEACHTREE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3069
Mailing Address - Country:US
Mailing Address - Phone:301-390-3128
Mailing Address - Fax:
Practice Address - Street 1:1809 PEACHTREE LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3069
Practice Address - Country:US
Practice Address - Phone:301-390-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001264500Medicaid