Provider Demographics
NPI:1407192214
Name:DUBOLS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:DUBOLS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YEWANDE
Authorized Official - Middle Name:D
Authorized Official - Last Name:AWOYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-497-8968
Mailing Address - Street 1:14440 CHERRY LANE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4946
Mailing Address - Country:US
Mailing Address - Phone:301-497-8968
Mailing Address - Fax:301-490-8668
Practice Address - Street 1:14440 CHERRY LANE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4946
Practice Address - Country:US
Practice Address - Phone:301-497-8968
Practice Address - Fax:301-490-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD421136700Medicaid
MDR3147OtherSTATE OF MD (DHMH)