Organization
DVA HEALTHCARE OF MARYLAND LLC
Active
Other names
Lakeside Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
10401 HOSPITAL DR STE G2, CLINTON, MD 20735-3113
(301) 856-6550
(301) 856-5693
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
(615) 320-4214
(866) 944-3352
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2564
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033165700
—
DC
05
—
1568422459
—
VA
05
—
429285500
—
MD
Enumeration date
03/24/2006
Last updated
04/20/2021
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