Provider Demographics
NPI:1982671640
Name:ACCESS ABILITY ORTHOTICS, LLC
Entity Type:Organization
Organization Name:ACCESS ABILITY ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RANDY
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:301-776-5200
Mailing Address - Street 1:14300 CHERRY LANE CT
Mailing Address - Street 2:SUITE 213
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4958
Mailing Address - Country:US
Mailing Address - Phone:301-776-5200
Mailing Address - Fax:301-776-4480
Practice Address - Street 1:14300 CHERRY LANE CT
Practice Address - Street 2:SUITE 213
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4958
Practice Address - Country:US
Practice Address - Phone:301-776-5200
Practice Address - Fax:301-776-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCO001692335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD510324000Medicaid
MK79OtherBC/BS OF MD
VA009190937Medicaid
115716OtherAMERIGROUP
100699OtherJOHNS HOPKINS HEALTHCARE
525679OtherNCPPO
K2930001OtherBLUECROSS/BLUESHIELD/NCA
DC034984200Medicaid
465167OtherANTHEM BLUECROSS
MD510324000Medicaid