Provider Demographics
NPI:1235370594
Name:ADVANTAGEOUS MD LLC
Entity Type:Organization
Organization Name:ADVANTAGEOUS MD LLC
Other - Org Name:ADVANTAGEOUS MEDICAL DEVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-351-0832
Mailing Address - Street 1:1728 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4533
Mailing Address - Country:US
Mailing Address - Phone:757-351-0832
Mailing Address - Fax:800-715-4039
Practice Address - Street 1:1728 VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4533
Practice Address - Country:US
Practice Address - Phone:757-351-0832
Practice Address - Fax:800-715-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6345380001Medicare NSC