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General NPI Number Information
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NPI Number | 1295485365
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Entity Type | Organization
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Legal Business Name | MARYLAND REAL LIFE DESIGNS, LLC
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 1815 W 13TH ST STE 4
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City | WILMINGTON
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State | DE
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Zip | 19806-4054
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Country | US
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Telephone | 410-569-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 3435 BOX HILL CORPORATE CENTER DR STE D
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City | ABINGDON
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State | MD
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Zip | 21009-1204
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Country | US
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Telephone |
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Fax | 410-569-7477
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONAS WALTER SEEBERG
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Credential |
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Telephone | 410-569-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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