MEDICARE: AMERICOAST MARYLAND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	D01734	MD
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)	R2267	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154434819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICOAST MARYLAND LLC

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 INNOVATION ST STE H-L
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2179
Country	:	US
Telephone Number	:	410-202-2784
Fax Number	:	410-918-0633

Authorized Official
Title or Position	:	CCO
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	12/12/2025

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Directions to “AMERICOAST MARYLAND LLC ” Practice Location

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