MEDICARE: ALPHA MEDICAL SUPPLY 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	:	1174136865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	9203 OXON HILL RD
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-4834
Country	:	US
Telephone Number	:	571-399-5318
Fax Number	:

Provider Business Practice Location Address
First Line	:	9203 OXON HILL RD
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-4834
Country	:	US
Telephone Number	:	571-399-5318
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SOLOMON G ABEBE
Credential	:
Telephone Number	:	571-399-5318

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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