Organization
DVA HEALTHCARE OF MARYLAND LLC
Active
Other names
Frederick 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
140 THOMAS JOHNSON DR, STE 100, FREDERICK, MD 21702-4475
(301) 695-0900
(301) 695-2808
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2598
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007727620017
—
PA
05
—
3810015779
—
WV
05
—
408119600
—
MD
Enumeration date
03/27/2006
Last updated
12/05/2024
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