MEDICARE: JESSA MEDICAL SUPPLY, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	R1058	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	:	1720033913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSA MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	235 KENTLANDS BLVD
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-5446
Country	:	US
Telephone Number	:	301-990-8706
Fax Number	:	240-631-7113

Provider Business Practice Location Address
First Line	:	235 KENTLANDS BLVD
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-5446
Country	:	US
Telephone Number	:	301-990-8706
Fax Number	:	240-631-7113

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MUSE ALIYEV
Credential	:
Telephone Number	:	301-990-8706

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	02/27/2024

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Directions to “JESSA MEDICAL SUPPLY, INC. ” Practice Location

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