Healthcare Provider Details

I. General information

NPI: 1912090432
Provider Name (Legal Business Name): MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 21ST ST NW SUITE 1000
WASHINGTON DC
20036-3390
US

IV. Provider business mailing address

1133 21ST ST NW SUITE 1000
WASHINGTON DC
20036-3390
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-9040
  • Fax: 202-223-9047
Mailing address:
  • Phone: 202-223-9040
  • Fax: 202-223-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberHFD06 0105
License Number StateDC

VIII. Authorized Official

Name: SUSAN P. LAWLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 202-416-2141