Healthcare Provider Details

I. General information

NPI: 1144527078
Provider Name (Legal Business Name): WATERFRONT SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 LIGHTHOUSE PT E SUITE 404
BALTIMORE MD
21224-4777
US

IV. Provider business mailing address

2700 LIGHTHOUSE PT E SUITE 404
BALTIMORE MD
21224-4777
US

V. Phone/Fax

Practice location:
  • Phone: 443-599-4000
  • Fax: 443-599-4012
Mailing address:
  • Phone: 443-599-4000
  • Fax: 443-599-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANEESH C SHARMA
Title or Position: MEDICAL DIRECTOR-OWNER
Credential: MD
Phone: 443-599-4000