Healthcare Provider Details

I. General information

NPI: 1548528169
Provider Name (Legal Business Name): HEALTH CARE DEPOT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 CHERRY LANE CT SUITE 115
LAUREL MD
20707-4946
US

IV. Provider business mailing address

14440 CHERRY LANE CT SUITE 115
LAUREL MD
20707-4946
US

V. Phone/Fax

Practice location:
  • Phone: 888-992-1363
  • Fax: 888-982-1363
Mailing address:
  • Phone: 888-992-1363
  • Fax: 888-982-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberR3248
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberR3248
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberR3248
License Number StateMD

VIII. Authorized Official

Name: MR. DAVE PATEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-629-7311