Healthcare Provider Details

I. General information

NPI: 1033524855
Provider Name (Legal Business Name): KENT ISLAND SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MAIN ST SUITE 215A
CHESTER MD
21619-2791
US

IV. Provider business mailing address

2661 RIVA RD BUILDING 100 SUITE 115
ANNAPOLIS MD
21401-7353
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9000
  • Fax: 410-571-1670
Mailing address:
  • Phone: 443-458-5132
  • Fax: 443-221-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN S KAHAN
Title or Position: MEMBER
Credential: D.O.
Phone: 410-571-9000