Provider Demographics
NPI:1104060482
Name:M & M MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:M & M MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-891-1111
Mailing Address - Street 1:6480 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4716
Mailing Address - Country:US
Mailing Address - Phone:301-891-1111
Mailing Address - Fax:301-891-1119
Practice Address - Street 1:6480 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4716
Practice Address - Country:US
Practice Address - Phone:301-891-1111
Practice Address - Fax:301-891-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15359316332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15359316OtherSTATE OF MARYLAND