Provider Demographics
NPI:1396072914
Name:MEDDIRECT TRANSPORT LLC
Entity type:Organization
Organization Name:MEDDIRECT TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORJA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-686-9630
Mailing Address - Street 1:10004 PAXTON ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1624
Mailing Address - Country:US
Mailing Address - Phone:443-686-9630
Mailing Address - Fax:888-317-0248
Practice Address - Street 1:10004 PAXTON ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21133-1624
Practice Address - Country:US
Practice Address - Phone:443-686-9630
Practice Address - Fax:888-317-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)