Provider Demographics
NPI:1417998345
Name:B.W. SURGICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:B.W. SURGICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDBLYUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-946-1888
Mailing Address - Street 1:10556 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2606
Mailing Address - Country:US
Mailing Address - Phone:301-946-1888
Mailing Address - Fax:301-946-4479
Practice Address - Street 1:10556 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2606
Practice Address - Country:US
Practice Address - Phone:301-946-1888
Practice Address - Fax:301-946-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD950401000Medicaid
VA1417998345Medicaid
MD1210550001Medicare NSC