Provider Demographics
NPI:1245222652
Name:DYNQUEST, INC.
Entity Type:Organization
Organization Name:DYNQUEST, INC.
Other - Org Name:DYNQUEST MEDICAL AND DYNQUEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-846-0002
Mailing Address - Street 1:8550 LEE HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1519
Mailing Address - Country:US
Mailing Address - Phone:703-846-0002
Mailing Address - Fax:703-846-0014
Practice Address - Street 1:8550 LEE HWY STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1519
Practice Address - Country:US
Practice Address - Phone:703-846-0002
Practice Address - Fax:703-846-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB-000099607332B00000X, 332BC3200X, 332BP3500X
VA02010043563336C0003X
VA90003336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009107355Medicaid
VA520075OtherNCPPO
MD768400200Medicaid
MD768400200Medicaid