Provider Demographics
NPI:1669481602
Name:MD SLEEP MED LLC
Entity Type:Organization
Organization Name:MD SLEEP MED LLC
Other - Org Name:AMERICAN SLEEP MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPOURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-254-4161
Mailing Address - Street 1:660 KENILWORTH DR STE 203
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2354
Mailing Address - Country:US
Mailing Address - Phone:410-296-5544
Mailing Address - Fax:410-296-5535
Practice Address - Street 1:660 KENILWORTH DRIVE
Practice Address - Street 2:203
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2354
Practice Address - Country:US
Practice Address - Phone:410-296-5544
Practice Address - Fax:410-296-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFMS007Medicare ID - Type Unspecified