Healthcare Provider Details

I. General information

NPI: 1871866988
Provider Name (Legal Business Name): FORT ASHBY BUSINESS ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225A NATIONAL HWY
LAVALE MD
21502-7602
US

IV. Provider business mailing address

1225A NATIONAL HIGHWAY
LAVALE MD
21502
US

V. Phone/Fax

Practice location:
  • Phone: 301-729-1144
  • Fax:
Mailing address:
  • Phone: 301-729-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MELVIN KEITH NESTER SR.
Title or Position: OWNER/OPERATOR
Credential: NBC-HIS
Phone: 304-298-4404