Provider Demographics
NPI:1932144219
Name:ADVANTAGE DIABETIC SUPPLY
Entity Type:Organization
Organization Name:ADVANTAGE DIABETIC SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZAGHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-446-0381
Mailing Address - Street 1:7225 HANOVER PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2024
Mailing Address - Country:US
Mailing Address - Phone:301-446-0381
Mailing Address - Fax:301-446-0384
Practice Address - Street 1:7225 HANOVER PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2024
Practice Address - Country:US
Practice Address - Phone:301-446-0381
Practice Address - Fax:301-446-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1246400001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER