Provider Demographics
NPI:1942497813
Name:HEALTHCARE DEPOT
Entity Type:Organization
Organization Name:HEALTHCARE DEPOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-805-7970
Mailing Address - Street 1:8624 CORY DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4461
Mailing Address - Country:US
Mailing Address - Phone:301-805-7970
Mailing Address - Fax:301-809-9314
Practice Address - Street 1:8624 CORY DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4461
Practice Address - Country:US
Practice Address - Phone:301-805-7970
Practice Address - Fax:301-809-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherEIN