Provider Demographics
NPI:1568611804
Name:ABBA MEDICAL SUPPLIES CORPORATION
Entity Type:Organization
Organization Name:ABBA MEDICAL SUPPLIES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AKINOLA
Authorized Official - Middle Name:HANSON
Authorized Official - Last Name:ADEJUWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-478-5294
Mailing Address - Street 1:239 S BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5951
Mailing Address - Country:US
Mailing Address - Phone:443-350-9094
Mailing Address - Fax:443-350-9092
Practice Address - Street 1:142 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5541
Practice Address - Country:US
Practice Address - Phone:443-485-6804
Practice Address - Fax:443-485-6805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABBA MEDICAL SUPPLIES CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-11
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07282649332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4410300001Medicare NSC