Provider Demographics
NPI:1851958193
Name:SILVER SPRING MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:SILVER SPRING MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SADOUGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-641-8735
Mailing Address - Street 1:831 UNIVERSITY BLVD E STE 21
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2920
Mailing Address - Country:US
Mailing Address - Phone:240-235-5082
Mailing Address - Fax:
Practice Address - Street 1:831 UNIVERSITY BLVD E STE 21
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2920
Practice Address - Country:US
Practice Address - Phone:240-235-5082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD907190300Medicaid