Organization
MARYLAND REAL LIFE DESIGNS, LLC
Active
Other names
Real Life Prosthetics
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA YEATER (MEMBER/CFO)
(410) 569-0606
Entity
Organization
Contact information
Practice address
100 BIDDLE AVE, SUITE 100, NEWARK, DE 19702-3981
(302) 392-1947
Mailing address
3435 BOX HILL CORPORATE CENTER DR, SUITE D, ABINGDON, MD 21009-1204
(410) 569-0606
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01110310
—
MD
01
—
4090110001
MEDICARE PROVIDER NUMBER
MD
01
—
4090110002
MEDICARE JA
MD
Enumeration date
09/30/2010
Last updated
01/11/2022
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