Healthcare Provider Details

I. General information

NPI: 1023199601
Provider Name (Legal Business Name): ANNE ARUNDEL UROLOGICAL SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIDGELY AVE STE 130
ANNAPOLIS MD
21401-1045
US

IV. Provider business mailing address

600 RIDGELY AVE STE 130
ANNAPOLIS MD
21401-1045
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-8049
  • Fax: 410-266-8054
Mailing address:
  • Phone: 410-266-8049
  • Fax: 410-266-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1235
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License NumberA1235
License Number StateMD

VIII. Authorized Official

Name: MARA HOLTON
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 410-266-8049