MEDICARE: HAJMOUD TRANSPORTATION 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1780219311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAJMOUD TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3212 REED ST APT 2734
Second Line	:
City	:	GLENARDEN
State	:	MD
Zip	:	20706-1553
Country	:	US
Telephone Number	:	240-476-9385
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 REED ST APT 2734
Second Line	:
City	:	GLENARDEN
State	:	MD
Zip	:	20706-1553
Country	:	US
Telephone Number	:	240-476-9385
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS HAJI Z SACCOH
Credential	:	MD
Telephone Number	:	240-476-9385

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	03/04/2020

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