Provider Demographics
NPI:1225232911
Name:HOME DELIVERY DIABETIC SUPPLY
Entity Type:Organization
Organization Name:HOME DELIVERY DIABETIC SUPPLY
Other - Org Name:FREEDOM DIABETIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-641-1811
Mailing Address - Street 1:9928 OLD OCEAN CITY BLVD
Mailing Address - Street 2:UNIT 9
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1122
Mailing Address - Country:US
Mailing Address - Phone:410-641-1811
Mailing Address - Fax:410-641-1170
Practice Address - Street 1:9928 OLD OCEAN CITY BLVD
Practice Address - Street 2:UNIT 9
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1122
Practice Address - Country:US
Practice Address - Phone:410-641-1811
Practice Address - Fax:410-641-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4441750001Medicare NSC