Healthcare Provider Details

I. General information

NPI: 1861726424
Provider Name (Legal Business Name): MARYLAND REAL LIFE DESIGNS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIDDLE AVE SUITE 212
NEWARK DE
19702-3969
US

IV. Provider business mailing address

3435 BOX HILL CORPORATE CENTER DR SUITE D
ABINGDON MD
21009-1204
US

V. Phone/Fax

Practice location:
  • Phone: 302-392-1947
  • Fax: 410-569-7477
Mailing address:
  • Phone: 410-569-0606
  • Fax: 410-569-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number2006602592
License Number StateDE

VIII. Authorized Official

Name: JONAS W SEEBERG
Title or Position: PRESIDENT
Credential: CPO
Phone: 410-569-0606