Provider Demographics
NPI:1447435730
Name:WESTERN MARYLAND PERITONEAL DIALYSIS, LLC
Entity type:Organization
Organization Name:WESTERN MARYLAND PERITONEAL DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:REPAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-723-6414
Mailing Address - Street 1:600 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3765
Mailing Address - Country:US
Mailing Address - Phone:301-723-4031
Mailing Address - Fax:301-723-1480
Practice Address - Street 1:600 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3765
Practice Address - Country:US
Practice Address - Phone:301-723-4031
Practice Address - Fax:301-723-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment