Provider Demographics
NPI:1396329579
Name:POTOMAC VALLEY HOME MEDICAL INC.
Entity type:Organization
Organization Name:POTOMAC VALLEY HOME MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:ADNAN
Authorized Official - Last Name:BEIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-722-6300
Mailing Address - Street 1:6721 SERVICEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7996
Mailing Address - Country:US
Mailing Address - Phone:240-644-8664
Mailing Address - Fax:301-722-4787
Practice Address - Street 1:6310 STEVENS FOREST RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1036
Practice Address - Country:US
Practice Address - Phone:301-722-6300
Practice Address - Fax:301-722-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDL0005158OtherMD LICENSE