Provider Demographics
NPI:1134184195
Name:WILLOW MEDICAL OF MARYLAND, INC.
Entity type:Organization
Organization Name:WILLOW MEDICAL OF MARYLAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:301-934-3046
Mailing Address - Street 1:PO BOX 2686
Mailing Address - Street 2:602 E. CHARLES STREET
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-2686
Mailing Address - Country:US
Mailing Address - Phone:301-934-3046
Mailing Address - Fax:301-934-2250
Practice Address - Street 1:602 EAST CHARLES ST
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-2686
Practice Address - Country:US
Practice Address - Phone:301-934-3046
Practice Address - Fax:301-934-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4784100001Medicare ID - Type UnspecifiedDME/HOME OXYGEN