Healthcare Provider Details

I. General information

NPI: 1750775268
Provider Name (Legal Business Name): SOUTHERN MARYLAND ENDOSCOPY CENTER ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE SUITE A103
CLINTON MD
20735-1628
US

IV. Provider business mailing address

7700 OLD BRANCH AVE SUITE A103
CLINTON MD
20735-1628
US

V. Phone/Fax

Practice location:
  • Phone: 301-877-4140
  • Fax:
Mailing address:
  • Phone: 301-877-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number207RG0100X
License Number StateMD

VIII. Authorized Official

Name: DR. JAMES S CHESLEY JR.
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 301-877-4140