Healthcare Provider Details

I. General information

NPI: 1326075250
Provider Name (Legal Business Name): SUBURBAN OUTPATIENT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 ROCKLEDGE DR STE 2100
BETHESDA MD
20817-7841
US

IV. Provider business mailing address

PO BOX 79520
BALTIMORE MD
21279-0520
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-6002
  • Fax:
Mailing address:
  • Phone: 301-896-6002
  • Fax: 301-230-1927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1351
License Number StateMD

VIII. Authorized Official

Name: PAT O'BOYLE
Title or Position: DIRECTOR, PATIENT FINANCIAL SRVCS
Credential:
Phone: 301-896-6002