Provider Demographics
NPI:1275559916
Name:MANDAD MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:MANDAD MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MANWERE
Authorized Official - Last Name:OPOKU-MANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-580-9790
Mailing Address - Street 1:1816 FEATHERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3413
Mailing Address - Country:US
Mailing Address - Phone:703-441-1791
Mailing Address - Fax:703-441-1793
Practice Address - Street 1:1816 FEATHERSTONE RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-441-1791
Practice Address - Fax:703-441-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010227976Medicaid
VA5685790001Medicare NSC