Provider Demographics
NPI:1144773128
Name:DEACC MEDICAL LLC
Entity Type:Organization
Organization Name:DEACC MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-275-4457
Mailing Address - Street 1:4500 FORBES BLVD # 200E16
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6312
Mailing Address - Country:US
Mailing Address - Phone:301-270-1383
Mailing Address - Fax:301-270-1296
Practice Address - Street 1:4500 FORBES BLVD # 200E16
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6312
Practice Address - Country:US
Practice Address - Phone:301-270-1383
Practice Address - Fax:301-270-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies