Healthcare Provider Details

I. General information

NPI: 1760312219
Provider Name (Legal Business Name): CORETAIL MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 HOLLY AVE APT 309
ANNAPOLIS MD
21401-4082
US

IV. Provider business mailing address

2500 W MORELAND RD STE 1081
WILLOW GROVE PA
19090-4024
US

V. Phone/Fax

Practice location:
  • Phone: 832-155-3155
  • Fax: 313-555-6666
Mailing address:
  • Phone: 852-553-5568
  • Fax: 648-633-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD HASSAN
Title or Position: CEO
Credential:
Phone: 832-568-8666