Healthcare Provider Details

I. General information

NPI: 1689731275
Provider Name (Legal Business Name): HAWKEYE MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY SUITE 126
COLUMBIA MD
21044-3264
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY SUITE 126
COLUMBIA MD
21044-3264
US

V. Phone/Fax

Practice location:
  • Phone: 443-832-4244
  • Fax: 443-832-4375
Mailing address:
  • Phone: 443-832-4244
  • Fax: 443-832-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. ASHOK F KAPUR
Title or Position: MANAGER
Credential:
Phone: 443-832-4244