MEDICARE: INDEPENDENT DIALYSIS FOUNDATION, 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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	E2549R	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS6	OTHER	MD	FEP
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	590079-01	OTHER	MD	CAREFIRST
5	0125608	OTHER	MD	AETNA
6	21506	OTHER	MD	JAI MEDICAL
7	215143	OTHER	MD	MDIPA
8	0704865003	OTHER	MD	CIGNA

General Provider Information

NPI Number	:	1669480422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT DIALYSIS FOUNDATION, INC

Provider Business Mailing Address
First Line	:	840 HOLLINS ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1024
Country	:	US
Telephone Number	:	410-468-0900
Fax Number	:	410-468-0911

Provider Business Practice Location Address
First Line	:	225 W DARES BEACH RD
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3123
Country	:	US
Telephone Number	:	410-468-0900
Fax Number	:	410-468-0911

Authorized Official
Title or Position	:	DIRECTOR OF INFORMATION SYSTEMS
Name	:	ZEKE AYELE
Credential	:
Telephone Number	:	410-468-0900

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/16/2007

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Directions to “INDEPENDENT DIALYSIS FOUNDATION, INC ” Practice Location

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