Healthcare Provider Details

I. General information

NPI: 1962449652
Provider Name (Legal Business Name): PLAZA AMBULATORY SURGICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 REISTERSTOWN RD
BALTIMORE MD
21215-2304
US

IV. Provider business mailing address

6506 REISTERSTOWN RD
BALTIMORE MD
21215-2304
US

V. Phone/Fax

Practice location:
  • Phone: 410-764-7044
  • Fax: 410-764-8637
Mailing address:
  • Phone: 410-764-7044
  • Fax: 410-764-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1175
License Number StateMD

VIII. Authorized Official

Name: DR. BRIAN KASHAN
Title or Position: OWNER
Credential: D.P.M.
Phone: 410-764-7044