Healthcare Provider Details

I. General information

NPI: 1396329579
Provider Name (Legal Business Name): POTOMAC VALLEY HOME MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 STEVENS FOREST RD
COLUMBIA MD
21046-1036
US

IV. Provider business mailing address

6721 SERVICEBERRY DR
FREDERICK MD
21703-7996
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-6300
  • Fax: 301-722-4787
Mailing address:
  • Phone: 240-644-8664
  • Fax: 301-722-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: WALEED ADNAN BEIDAS
Title or Position: PRESIDENT
Credential:
Phone: 301-722-6300