Provider Demographics
NPI:1295828051
Name:ADVANCED DIALYSIS CENTER
Entity Type:Organization
Organization Name:ADVANCED DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINESSIA
Authorized Official - Middle Name:ZARITA
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:301-943-7808
Mailing Address - Street 1:9320 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3100
Mailing Address - Country:US
Mailing Address - Phone:301-577-1007
Mailing Address - Fax:301-577-1006
Practice Address - Street 1:9101 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-3521
Practice Address - Country:US
Practice Address - Phone:410-496-0077
Practice Address - Fax:410-496-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE2642R261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212642Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER