Active NPI
Medivance Supply LLC
- Clinical Medical Laboratory
- Waldorf, MD
National Provider Identifier
1548174154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- MEDIVANCE SUPPLY LLC
- Practice address
- 2009 Saint Thomas Dr Apt 208
Waldorf, MD 20602-2175 - Phone
- (835) 658-9321
- NPI assigned
- Sep 30, 2026
- Last updated
- Sep 30, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Imran Kashif
- Title
- Ceo
- Phone
- (835) 658-9321
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | NU | Primary |
Addresses
Primary practice location
2009 Saint Thomas Dr Apt 208
Waldorf, MD 20602-2175
Mailing address
2009 Saint Thomas Dr Apt 208
Waldorf, MD 20602-2175
Phone (835) 658-9321
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790726400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1790726400000",
"number": "1548174154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2009 SAINT THOMAS DR APT 208",
"city": "WALDORF",
"state": "MD",
"postal_code": "206022175",
"telephone_number": "835-658-9321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2009 SAINT THOMAS DR APT 208",
"city": "WALDORF",
"state": "MD",
"postal_code": "206022175",
"telephone_number": "835-658-9321"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDIVANCE SUPPLY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-30",
"last_updated": "2026-09-30",
"certification_date": "2026-09-30",
"status": "A",
"authorized_official_last_name": "KASHIF",
"authorized_official_first_name": "IMRAN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "835-658-9321"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
- Delia Contreras Meadows, LCSW-C, ICSW, LCSW
- Daniel Jonathan Meckel, PHD LGSW
- Med36-5
- Medexpress Urgent Care, PC - Maryland (MedExpress Urgent Care - Waldorf, Crain Hwy)
- Medicine of Essence (Medicine of Essence LLC)
- Medstar Medical Group - Southern Maryland LLC (MedStar Shah Medical Group LLC)
- Medstar Medical Group - Southern Maryland LLC
- Medstar Medical Group - Southern Maryland LLC
- Medstar Medical Group II LLC
- Medstar Medical Group II LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.