Healthcare Provider Details

I. General information

NPI: 1073787834
Provider Name (Legal Business Name): LAUREL MEDICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179B THOMAS JOHNSON DRIVE
FREDERICK MD
21702-4871
US

IV. Provider business mailing address

179B THOMAS JOHNSON DRIVE
FREDERICK MD
21702-4871
US

V. Phone/Fax

Practice location:
  • Phone: 301-378-2266
  • Fax: 301-378-2204
Mailing address:
  • Phone: 301-378-2266
  • Fax: 301-378-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberR2549
License Number StateMD

VIII. Authorized Official

Name: MR. JOHN J LETIZIA
Title or Position: PRESIDENT
Credential: ATP
Phone: 814-472-5591