Healthcare Provider Details

I. General information

NPI: 1073206421
Provider Name (Legal Business Name): VIVA DME LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5534 TUXEDO RD
HYATTSVILLE MD
20781-1318
US

IV. Provider business mailing address

14280 BALTIMORE AVE # 1001
LAUREL MD
20707-5006
US

V. Phone/Fax

Practice location:
  • Phone: 301-684-8411
  • Fax:
Mailing address:
  • Phone: 301-684-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. OPPONG GYAMFI
Title or Position: MANAGER
Credential:
Phone: 301-684-8411