Provider Demographics
NPI:1447581764
Name:NATIONAL MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:NATIONAL MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HABIBOLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULOUBANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-213-5556
Mailing Address - Street 1:6320 MARLBORO PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2878
Mailing Address - Country:US
Mailing Address - Phone:301-213-5556
Mailing Address - Fax:
Practice Address - Street 1:6320 MARLBORO PIKE STE A
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2878
Practice Address - Country:US
Practice Address - Phone:301-213-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16371643332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies