Provider Demographics
NPI:1265917017
Name:HAGERSTOWN INFUSION, LLC
Entity type:Organization
Organization Name:HAGERSTOWN INFUSION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-707-6687
Mailing Address - Street 1:1829 HOWELL RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6606
Mailing Address - Country:US
Mailing Address - Phone:240-707-6687
Mailing Address - Fax:800-616-7071
Practice Address - Street 1:1829 HOWELL RD STE 2B
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6606
Practice Address - Country:US
Practice Address - Phone:240-707-6687
Practice Address - Fax:800-626-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy