Healthcare Provider Details

I. General information

NPI: 1841362720
Provider Name (Legal Business Name): GENERAL SURGERY AMBULATORY SURGICAL CENTER, A.S.C., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N CALVERT ST SUITE 655
BALTIMORE MD
21218-2867
US

IV. Provider business mailing address

PO BOX 10714
TOWSON MD
21285-0714
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-8720
  • Fax: 410-321-8723
Mailing address:
  • Phone: 410-321-8720
  • Fax: 410-321-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1289
License Number StateMD

VIII. Authorized Official

Name: MAEN J. FARHA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-321-8720