Healthcare Provider Details

I. General information

NPI: 1215041983
Provider Name (Legal Business Name): MEDSTAR HEALTH INFUSION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7379 WASHINGTON BLVD
ELKRIDGE MD
21075-6329
US

IV. Provider business mailing address

7379 WASHINGTON BLVD
ELKRIDGE MD
21075-6329
US

V. Phone/Fax

Practice location:
  • Phone: 410-540-4450
  • Fax: 410-540-4430
Mailing address:
  • Phone: 410-540-4450
  • Fax: 410-540-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberPW0199
License Number StateMD

VIII. Authorized Official

Name: MS. CARMEN LOTT
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 410-540-4419