Provider Demographics
NPI:1619913357
Name:MD MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:MD MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOLEVSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-642-7048
Mailing Address - Street 1:803 BARKWOOD CT STE F
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1426
Mailing Address - Country:US
Mailing Address - Phone:410-685-8159
Mailing Address - Fax:410-685-8160
Practice Address - Street 1:803 BARKWOOD CT STE F
Practice Address - Street 2:
Practice Address - City:LINTHICUM HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21090-1426
Practice Address - Country:US
Practice Address - Phone:410-685-8159
Practice Address - Fax:410-685-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408215001Medicaid
MD11608411OtherCENTRAL REGISTRATION NUMBER