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General NPI Number Information
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NPI Number | 1942218797
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Entity Type | Organization
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Legal Business Name | INDEPENDENT DIALYSIS FOUNDATION, INC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 804 LANDMARK DR SUITE 112
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City | GLEN BURNIE
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State | MD
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Zip | 21061-4486
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Country | US
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Telephone | 410-468-0900
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Fax | 410-468-0911
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Provider Business Mailing Address
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Address Line | 840 HOLLINS ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1024
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Country | US
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Telephone | 410-468-0900
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Fax | 410-468-0911
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Authorized Official
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Title or Position | DIRECTOR OF INFORMATION SYSTEMS
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Name | ZEKE AYELE
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Credential |
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Telephone | 410-468-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | E2544R
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License Number State | MD
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