Healthcare Provider Details

I. General information

NPI: 1538339221
Provider Name (Legal Business Name): SLEEP DISORDERS CTRS OF THE MID ATLANTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 OLD MILL BOTTOM RD N STE 102
ANNAPOLIS MD
21401-5410
US

IV. Provider business mailing address

2235 CEDAR LN SUITE 202
VIENNA VA
22182-5202
US

V. Phone/Fax

Practice location:
  • Phone: 410-757-1297
  • Fax: 410-757-1299
Mailing address:
  • Phone: 703-752-7881
  • Fax: 703-752-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMD

VIII. Authorized Official

Name: JAMES R PERLSTROM
Title or Position: PRESIDENT
Credential: PHD
Phone: 703-752-7881