Provider Demographics
NPI:1164479689
Name:JOSEPHINE'S DURABLE MEDICAL EQUP. SUPPLIES
Entity Type:Organization
Organization Name:JOSEPHINE'S DURABLE MEDICAL EQUP. SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-306-6017
Mailing Address - Street 1:23 DEFENSE DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3805
Mailing Address - Country:US
Mailing Address - Phone:410-306-6017
Mailing Address - Fax:410-306-6117
Practice Address - Street 1:23 DEFENSE DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3805
Practice Address - Country:US
Practice Address - Phone:410-306-6017
Practice Address - Fax:410-306-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12203407251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health