Provider Demographics
NPI:1053926212
Name:SIERRA MEDICAL SUPPLY,LLC
Entity type:Organization
Organization Name:SIERRA MEDICAL SUPPLY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FODAY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-286-2640
Mailing Address - Street 1:8831 LOTTSFORD RD APT 517
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4870
Mailing Address - Country:US
Mailing Address - Phone:240-286-2640
Mailing Address - Fax:
Practice Address - Street 1:6492 LANDOVER RD STE D
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1434
Practice Address - Country:US
Practice Address - Phone:240-286-2640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies