Healthcare Provider Details

I. General information

NPI: 1396876629
Provider Name (Legal Business Name): CHEVY CHASE SURGICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5530 WISCONSIN AVE SUITE 1455
CHEVY CHASE MD
20815-4404
US

IV. Provider business mailing address

PO BOX 70626
CHEVY CHASE MD
20813-0626
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-6700
  • Fax: 301-656-6701
Mailing address:
  • Phone: 301-656-6700
  • Fax: 301-656-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD35110
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberD35110
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001332
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001639
License Number StateMD

VIII. Authorized Official

Name: DR. THOMAS G ZORC
Title or Position: PRESIDENT
Credential: MD
Phone: 301-656-6700