Organization
MEDSTAR HEALTH INFUSION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARMEN LOTT RN (EXECUTIVE DIRECTOR)
(410) 540-4419
Entity
Organization
Contact information
Practice address
7379 WASHINGTON BLVD, ELKRIDGE, MD 21075-6329
(410) 540-4450
(410) 540-4430
Mailing address
7379 WASHINGTON BLVD, ELKRIDGE, MD 21075-6329
(410) 540-4450
(410) 540-4430
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
PW0199
MD
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008508003
—
VA
05
—
009105352
—
VA
05
—
028880900
—
DC
05
—
051003300
—
MD
01
—
1033
BCBS OF DC
—
01
—
2456341
AETNA HMO
—
01
—
4540209
AETNA PPO
—
01
—
58886
AMERICAID
—
01
—
62062201
BCBS OF MARYLAND
—
05
—
953901800
—
MD
Enumeration date
08/18/2006
Last updated
04/29/2009
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