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Organization

PRESTIGE DIALYSIS CLINIC, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL LOUIS WILEY (CEO)
(301) 203-9164
Entity
Organization

Contact information

Practice address
4700 HARFORD RD, BALTIMORE, MD 21214-3204
(410) 254-3300
(410) 254-3015
Mailing address
15413 MAPLE DR, ACCOKEEK, MD 20607-2016
(301) 203-9164

Taxonomy

Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary

Other

Enumeration date
11/25/2008
Last updated
11/25/2008
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