Healthcare Provider Details

I. General information

NPI: 1174453062
Provider Name (Legal Business Name): M DOUBLE U HOLDINGS, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HARRY S TRUMAN PKWY STE J
ANNAPOLIS MD
21401-7376
US

IV. Provider business mailing address

1305 BLUEGRASS WAY
GAMBRILLS MD
21054-1052
US

V. Phone/Fax

Practice location:
  • Phone: 240-304-0865
  • Fax: 240-234-2376
Mailing address:
  • Phone: 240-304-0865
  • Fax: 240-243-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: LA'SONIA NICOLE NICK-MCGRIFF
Title or Position: OWNER
Credential: STYLIST
Phone: 240-304-0865