Healthcare Provider Details

I. General information

NPI: 1386674323
Provider Name (Legal Business Name): HAVILAND CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19411 EXPLORER RIDGE RD
ROCKVILLE VA
23146-1552
US

IV. Provider business mailing address

19411 EXPLORER RIDGE RD
ROCKVILLE VA
23146-1552
US

V. Phone/Fax

Practice location:
  • Phone: 804-749-4598
  • Fax: 804-749-4398
Mailing address:
  • Phone: 804-749-4598
  • Fax: 804-749-4398

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. PAUL AUGUSTINE DONAGHY III
Title or Position: SECRETARY
Credential: N/A
Phone: 804-749-4598