Provider Demographics
NPI:1689997454
Name:DEEP SLEEP
Entity Type:Organization
Organization Name:DEEP SLEEP
Other - Org Name:DEEP SLEEP LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-620-1984
Mailing Address - Street 1:111 W HIGH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5529
Mailing Address - Country:US
Mailing Address - Phone:410-620-1984
Mailing Address - Fax:410-392-3450
Practice Address - Street 1:251 LEWIS LN
Practice Address - Street 2:SUITE 301A
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3751
Practice Address - Country:US
Practice Address - Phone:410-939-2711
Practice Address - Fax:410-939-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047471207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty