Healthcare Provider Details

I. General information

NPI: 1962717801
Provider Name (Legal Business Name): DURABLE MEDICAL EQUIPMENT SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 S VAN DORN ST APT 109
ALEXANDRIA VA
22304-4203
US

IV. Provider business mailing address

80 S VAN DORN ST APT 109
ALEXANDRIA VA
22304-4203
US

V. Phone/Fax

Practice location:
  • Phone: 703-945-2185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL AFEWORK
Title or Position: PRESIDENT
Credential:
Phone: 703-945-2185