Provider Demographics
NPI:1215041983
Name:MEDSTAR HEALTH INFUSION, INC.
Entity Type:Organization
Organization Name:MEDSTAR HEALTH INFUSION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-540-4419
Mailing Address - Street 1:7379 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6329
Mailing Address - Country:US
Mailing Address - Phone:410-540-4450
Mailing Address - Fax:410-540-4430
Practice Address - Street 1:7379 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6329
Practice Address - Country:US
Practice Address - Phone:410-540-4450
Practice Address - Fax:410-540-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW0199251F00000X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC028880900Medicaid
4540209OtherAETNA PPO
1033OtherBCBS OF DC
62062201OtherBCBS OF MARYLAND
VA008508003Medicaid
MD051003300Medicaid
VA009105352Medicaid
58886OtherAMERICAID
MD953901800Medicaid
2456341OtherAETNA HMO
VA009105352Medicaid