Healthcare Provider Details

I. General information

NPI: 1922566066
Provider Name (Legal Business Name): DELMARVA ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11103 CATHAGE RD
BERLIN MD
21811-2114
US

IV. Provider business mailing address

11103 CATHAGE RD
BERLIN MD
21811-2114
US

V. Phone/Fax

Practice location:
  • Phone: 410-847-7900
  • Fax: 410-847-7787
Mailing address:
  • Phone: 410-847-7900
  • Fax: 410-847-7787

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: TIMOTHY FEIST
Title or Position: BOARD MEMBER
Credential:
Phone: 410-543-7118