Provider Demographics
NPI:1639102072
Name:NEB DOCTORS OF MARYLAND LLC
Entity Type:Organization
Organization Name:NEB DOCTORS OF MARYLAND LLC
Other - Org Name:NEB DOCTORS OF MARYLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-588-9630
Mailing Address - Street 1:PO BOX 922189
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-2189
Mailing Address - Country:US
Mailing Address - Phone:888-588-9630
Mailing Address - Fax:888-835-3354
Practice Address - Street 1:5022 CAMPBELL BLVD STE I
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-335-6175
Practice Address - Fax:410-335-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037540500Medicaid
MD409672000Medicaid
MD409672000Medicaid