Provider Demographics
NPI:1316789027
Name:NOVA DIALYSIS WOODBINE
Entity type:Organization
Organization Name:NOVA DIALYSIS WOODBINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MINESSIA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:301-577-1007
Mailing Address - Street 1:9320 ANNAPOLIS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3121
Mailing Address - Country:US
Mailing Address - Phone:301-577-1007
Mailing Address - Fax:301-577-1006
Practice Address - Street 1:2729 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-4008
Practice Address - Country:US
Practice Address - Phone:301-577-1007
Practice Address - Fax:301-577-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment