Healthcare Provider Details

I. General information

NPI: 1649467630
Provider Name (Legal Business Name): SUMMIT AMBULATORY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD SUITE 307
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

25 CROSSROADS DR SUITE 306
OWINGS MILLS MD
21117-5421
US

V. Phone/Fax

Practice location:
  • Phone: 410-433-7303
  • Fax: 410-433-7755
Mailing address:
  • Phone: 443-738-2872
  • Fax: 443-738-2713

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. SANFORD J. SIEGEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-581-1600