Healthcare Provider Details

I. General information

NPI: 1982913711
Provider Name (Legal Business Name): 12325 NEW HAMPSHIRE AVENUE DIALYSIS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12325 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-2957
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 301-625-8890
  • Fax:
Mailing address:
  • Phone: 610-925-4436
  • Fax: 610-347-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: MICHAEL BERG
Title or Position: SECRETARY
Credential:
Phone: 104-444-6350