PRESTIGE DIALYSIS CLINIC, INC. (NPI# 1255586780) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255586780 |
| Entity Type | Organization |
| Organization Name | PRESTIGE DIALYSIS CLINIC, INC. |
| Practice Address |
4700 Harford Rd Baltimore MD 21214-3204 |
| Mailing Address |
15413 Maple Dr Accokeek MD 20607-2016 |
| Practice Telephone | 4102543300 |
| Practice Fax Number | 4102543015 |
| Mailing Telephone | 3012039164 |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2008-11-25 |
| Authorized Official Name | MR. MICHAEL LOUIS WILEY (CEO) |
| Authorized Official Telephone | 3012039164 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| Street Address |
4700 HARFORD RD |
| City | BALTIMORE |
| State | MD |
| Zip Code | 21214-3204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053427450 | Harborside Healthcare Baltimore Limited Partnership | Skilled Nursing Facility | 4700 Harford Rd, Baltimore, MD 21214-3204 | 2006-08-21 |
| 1356799712 | Coldspring Dialysis Clinic LLC | Clinic/Center | 4700 Harford Rd, Baltimore, MD 21214-3204 | 2016-05-26 |
| 1023472933 | Harford Road Health Care, LLC | Skilled Nursing Facility | 4700 Harford Rd, Baltimore, MD 21214-3204 | 2016-04-06 |
| 1306187919 | Michal Kulyk | Physical Therapist | 4700 Harford Rd, Baltimore, MD 21214-3204 | 2013-03-06 |
| 1336483858 | Kelly Donaldson | Occupational Therapy Assistant | 4700 Harford Rd, Baltimore, MD 21214-3204 | 2012-11-21 |
| 1922342435 | Patricia Feddon | Physical Therapy Assistant | 4700 Harford Rd, Baltimore, MD 21214-3204 | 2012-11-21 |
| 1538403043 | Debra Daugherty Kalm | Physical Therapy Assistant | 4700 Harford Rd, Baltimore, MD 21214-3204 | 2012-11-21 |
| 1275827677 | Harford Road Health Care, LLC | Skilled Nursing Facility | 4700 Harford Rd, Baltimore, MD 21214-3204 | 2011-06-02 |
| 1790956316 | Marison Millora Magno | Physical Therapist | 4700 Harford Rd, Baltimore, MD 21214-3204 | 2008-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811544034 | Emani Williams | Behavior Technician | 4606 Walker Avenue, Baltimore, MD 21214 | 2019-08-22 |
| 1457831166 | Smith Podiatry & Associates LLC | Clinic/Center | 5610 Harford Rd Ste A, Baltimore, MD 21214 | 2018-08-21 |
| 1013435387 | Marcus Motton | Clinic/Center | 5629 Harford Road, Baltimore, MD 21214 | 2017-09-06 |
| 1528432143 | Beverly Jean Tellis | Social Worker | 6310 Harford Road, Baltimore, MD 21214 | 2015-11-19 |
| 1972848745 | Amy M Young | Occupational Therapist | 5908 Edna Ave, Baltimore, MD 21214 | 2012-12-05 |
| 1306112693 | The Good Samaritan Hospital of Maryland, Inc. | Clinic/Center | 4700 Hartford Road, Baltimore, MD 21214 | 2012-03-30 |
| 1578731824 | Rebecca Michele Green | Speech-Language Pathologist | 5302 Plymouth Road, Baltimore, MD 21214 | 2008-02-20 |
| 1891975918 | Karen Schmidt | Occupational Therapist | 604 Hartford Rd., Baltimore, MD 21214 | 2007-11-06 |
| 1972790533 | Patricia Mary Marchetti Smith | Speech-Language Pathologist | 2709 Woodsdale Avenue, Baltimore, MD 21214 | 2007-09-27 |
| 1780896290 | Scott David Hubert | Dentist | 5810 Harford Rd, Baltimore, MD 21214 | 2007-05-04 |
| Find all providers in zip 21214 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639660962 | Renal Treatment Centers - Mid-atlantic, Inc. | Clinic/Center | 5315 York Rd, Baltimore, MD 21212-3830 | 2018-05-22 |
| 1851740096 | Northpoint Dialysis Clinic LLC | Clinic/Center | 1046 North Point Road, Baltimore, MD 21224 | 2016-06-08 |
| 1699121517 | Fresenius Medical Care Nw Baltimore, LLC | Clinic/Center | 2 Hamill Rd Ste 200, Baltimore, MD 21210-1817 | 2016-05-10 |
| 1689035693 | Baltimore County Dialysis, LLC | Clinic/Center | 407 N Caroline St Ste 100, Baltimore, MD 21231-1003 | 2016-03-18 |
| 1346621554 | Kidney Home Center, LLC | Clinic/Center | 200 Saint Paul St Ste 5, Baltimore, MD 21202-2025 | 2015-06-12 |
| 1942623129 | Braidwood Dialysis LLC | Clinic/Center | 200 Saint Paul Pl, Suite 5, Baltimore, MD 21202-2004 | 2014-01-24 |
| 1114351863 | The Good Samaritan Hospital of Maryland, Inc. | Clinic/Center | 1046 S Northpoint Rd, Baltimore, MD 21224-3307 | 2013-08-29 |
| 1821330952 | Fresenius Medical Care Essex Dundalk, LLC | Clinic/Center | 1107 N Point Blvd Ofc Park, Suite 201, Baltimore, MD 21224-3420 | 2013-03-27 |
| 1306112693 | The Good Samaritan Hospital of Maryland, Inc. | Clinic/Center | 4700 Hartford Road, Baltimore, MD 21214 | 2012-03-30 |
| 1073720827 | Bio Medical Applications of Maryland Inc | Clinic/Center | 1104 Walters Ave, Baltimore, MD 21239 | 2007-05-17 |
| Find all providers in BALTIMORE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.