Organization
HAVANNA DIALYSIS LLC
Active
Other names
Gaithersburg Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
202 PERRY PKWY STE 3, GAITHERSBURG, MD 20877-2172
(301) 987-0912
(301) 947-6115
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6600131
—
MD
Enumeration date
08/15/2017
Last updated
11/17/2025
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