Provider Demographics
NPI:1811187982
Name:DISTRICT MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:DISTRICT MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLE
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:BRADBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-322-9260
Mailing Address - Street 1:1801 BELLE HAVEN DR
Mailing Address - Street 2:302
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4022
Mailing Address - Country:US
Mailing Address - Phone:301-322-9260
Mailing Address - Fax:301-322-9171
Practice Address - Street 1:1801 BELLE HAVEN DR
Practice Address - Street 2:302
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4022
Practice Address - Country:US
Practice Address - Phone:301-322-9260
Practice Address - Fax:301-322-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0000000332B00000X
MD000000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies