Healthcare Provider Details

I. General information

NPI: 1225361751
Provider Name (Legal Business Name): SUBURBAN HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 ROCKLEDGE DR SUITE 4100
BETHESDA MD
20817-7837
US

IV. Provider business mailing address

SUBURBAN HOSPITAL INC PO BOX 79216
BALTIMORE MD
21279-0216
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-3856
  • Fax:
Mailing address:
  • Phone: 301-896-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN A GRAGNOLATI
Title or Position: PRESIDENT
Credential:
Phone: 301-896-2574