Provider Demographics
NPI:1215595822
Name:PARADIGM PROSTHETICS, LLC
Entity Type:Organization
Organization Name:PARADIGM PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-741-7038
Mailing Address - Street 1:10903 INDIAN HEAD HWY STE 312
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4005
Mailing Address - Country:US
Mailing Address - Phone:301-741-7038
Mailing Address - Fax:
Practice Address - Street 1:10903 INDIAN HEAD HWY STE 312
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4005
Practice Address - Country:US
Practice Address - Phone:301-741-7038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7763650001OtherMEDICARE
7763650001OtherMEDICARE