Healthcare Provider Details

I. General information

NPI: 1073644399
Provider Name (Legal Business Name): PRIVATE SURGICAL SUITE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/27/2010
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 71144
CHEVY CHASE MD
20813-1144
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-8008
  • Fax: 301-656-6701
Mailing address:
  • Phone: 301-656-8008
  • Fax: 301-656-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1291
License Number StateMD

VIII. Authorized Official

Name: DR. THOMAS G ZORC
Title or Position: MEMBER
Credential: MD
Phone: 301-656-8008