Organization
DVA HEALTHCARE OF MARYLAND LLC
Active
Other names
25th Street Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
920 E 25TH ST, BALTIMORE, MD 21218-5503
(410) 235-1611
(410) 235-3721
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4214
(866) 944-3352
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2595
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007727620014
—
PA
05
—
326000300
—
MD
Enumeration date
03/23/2006
Last updated
12/06/2021
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