MEDICARE: DEACC MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1144773128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEACC MEDICAL LLC

Provider Business Mailing Address
First Line	:	4500 FORBES BLVD # 200E16
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-6312
Country	:	US
Telephone Number	:	301-270-1383
Fax Number	:	301-270-1296

Provider Business Practice Location Address
First Line	:	4500 FORBES BLVD # 200E16
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-6312
Country	:	US
Telephone Number	:	301-270-1383
Fax Number	:	301-270-1296

Authorized Official
Title or Position	:	OWNER
Name	:	ERNEST OBIDIKE
Credential	:
Telephone Number	:	301-275-4457

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/20/2020

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