Healthcare Provider Details

I. General information

NPI: 1932352077
Provider Name (Legal Business Name): LANHAM DIALYSIS ACCESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 FORBES BLVD SUITE E
LANHAM MD
20706-4351
US

IV. Provider business mailing address

3001 PALM HARBOR BLVD STE A
PALM HARBOR FL
34683-1930
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-5535
  • Fax: 301-577-5536
Mailing address:
  • Phone: 727-474-0090
  • Fax: 727-474-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SANIL NATH
Title or Position: PARTNER
Credential: M.D.
Phone: 301-345-0605