Organization
MATTIE'S BRA SHOP
Active
Organization
MATTIE'S BRA SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MATTIE M. STANFORD (OWNER)
(410) 730-8402
Entity
Organization
Contact information
Practice address
8457 BALTIMORE NATIONAL PIKE, SUITE 17, ELLICOTT CITY, MD 21043-4209
(410) 750-7950
(410) 730-8402
Mailing address
5514 HARVEST SCENE CT, COLUMBIA, MD 21044-2705
(410) 730-8402
(410) 730-8402
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
361103505
—
MD
Enumeration date
08/31/2006
Last updated
06/18/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up