Organization
WESTERN MARYLAND MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS T CHAN (CFO)
(301) 790-8102
Entity
Organization
Contact information
Practice address
12101 WINCHESTER RD, SUITE 1A, LAVALE, MD 21502-7688
(301) 729-4280
(301) 729-2944
Mailing address
12101 WINCHESTER RD, SUITE 1A, LAVALE, MD 21502-7688
(301) 729-4280
(301) 729-2944
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
R1119
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
411305500
—
MD
Enumeration date
07/16/2006
Last updated
03/19/2015
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