Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Landover 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
1200 MERCANTILE LN, STE 105, UPPER MARLBORO, MD 20774-5389
(301) 322-2861
(301) 322-5829
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2545
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033657400
—
DC
05
—
1033179874
—
VA
05
—
763011500
—
MD
Enumeration date
03/24/2006
Last updated
06/02/2025
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