Victory Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

E2631 Issued in MD

Legal business name

VICTORY DIALYSIS LLC

Doing business as

Aviation Blvd Dialysis

Practice address

6934 Aviation Blvd
Ste K
Glen Burnie, MD 21061-2593

Phone

(410) 553-6951

Fax

(410) 766-0513

NPI assigned

May 5, 2011

Last updated

May 26, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Aviation Blvd Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Listed as

DaVita Aviation Blvd DialysisCCN 212631

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Apr 3, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

30

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Dva Healthcare Renal Care Inc

  dba Amelia Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Amelia Court House, VA
  • NPI 1861456113

  Member Of

  NPD member

Locations

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Anuradha Boddeti, M.D.

  • Nephrology Physician
  • Glen Burnie, MD
  • NPI 1023089471

  Dialysis facility

  Care Compare affiliation Name & address match
• Shahab A Khan, M.D.

  • Nephrology Physician
  • Glen Burnie, MD
  • NPI 1336182302

  Dialysis facility

  Care Compare affiliation Name & address match
• Tedine Ranich, M.D.

  • Nephrology Physician
  • Lutherville, MD
  • NPI 1669470100

  Dialysis facility

  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1255623534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6934 AVIATION BLVD",
            "address_2": "STE K",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210612593",
            "telephone_number": "410-553-6951",
            "fax_number": "410-766-0513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-05",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MD",
            "license": "E2631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402823600",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0351575 00",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aviation Blvd Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gayle Marie Verreault
• Julian Ezekiel Vesnovsky, DPT
• Modesta Vesonder, CRNP
• Mercy Viator, CRNP
• Neel K Vibhakar, M.D.
• Kevin Ellis Vieser, DC, ATC, CCSP
• Ines Maria Vigil, MD, MPH, MBA
• Samantha L. Villanueva, DPT
• Stephen T Villanyi, MD
• Shameeka Vines

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.