Provider Demographics
NPI:1295746527
Name:INDEPENDENT DIALYSIS FOUNDATION, INC
Entity type:Organization
Organization Name:INDEPENDENT DIALYSIS FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF IT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-468-0900
Mailing Address - Street 1:840 HOLLINS ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1024
Mailing Address - Country:US
Mailing Address - Phone:410-468-0900
Mailing Address - Fax:
Practice Address - Street 1:888 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-5101
Practice Address - Country:US
Practice Address - Phone:410-468-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0704865003OtherCIGNA
MD215143OtherUNITED HEALTHCARE
MD916856-01OtherCAREFIRST BLUE CROSS
MD0125608OtherAETNA
MDAC2OtherFEP
WV3810011315Medicaid
MD0704865003OtherCIGNA