MEDICARE: GRANDIFF MEDICAL SUPPLIES INC

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	R2253	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	10079260	OTHER	MD	AMERIGROUP

General Provider Information

NPI Number	:	1669428124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDIFF MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	20 VITAL WAY
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-3446
Country	:	US
Telephone Number	:	301-388-0596
Fax Number	:	301-388-0597

Provider Business Practice Location Address
First Line	:	20 VITAL WAY
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-3446
Country	:	US
Telephone Number	:	301-388-0596
Fax Number	:	301-388-0597

Authorized Official
Title or Position	:	DIRECTOR
Name	:	IMAOBONG NNSEWO AKPAETE
Credential	:
Telephone Number	:	301-388-0596

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	09/16/2008

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Directions to “GRANDIFF MEDICAL SUPPLIES INC ” Practice Location

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