Healthcare Provider Details

I. General information

NPI: 1154690451
Provider Name (Legal Business Name): DMEONSITE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11526 SENECA WOODS CT
GREAT FALLS VA
22066-1375
US

IV. Provider business mailing address

PO BOX 1048
GREAT FALLS VA
22066-9048
US

V. Phone/Fax

Practice location:
  • Phone: 703-348-7857
  • Fax: 703-444-4308
Mailing address:
  • Phone: 703-348-7857
  • Fax: 703-444-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PANKAJ MERCHIA
Title or Position: MANAGER
Credential:
Phone: 617-401-8929