Havanna Dialysis LLC
Clinic/Center, End-Stage Renal Disease (ESRD) Treatment in Gaithersburg, MD. Organization (NPI-2).
NPI number1013433713
StatusActive
Last updated in NPPESNov 17, 2025
Details
- NPI
- 1013433713
- Entity type
- Organization (NPI-2)
- Legal business name
- Havanna Dialysis LLC
- Organization subpart
- No
- Enumeration date
- Aug 15, 2017
- Certification date
- Nov 17, 2025
- Last updated
- Nov 17, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QE0700X | Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | – | MD | Yes |
Other names
- Gaithersburg Dialysis (Doing Business As)
Practice location
202 Perry Pkwy Ste 3Gaithersburg, MD 20877-2172
Phone 301-987-0912 · Fax 301-947-6115
Mailing address
5200 Virginia WayL&C Department
Brentwood, TN 37027-7569
Authorized official
Samuel T Wey
Vp Licensure & Certification
6153416641
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