Healthcare Provider Details

I. General information

NPI: 1760406110
Provider Name (Legal Business Name): MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE SUITE 104A
CLINTON MD
20735
US

IV. Provider business mailing address

10403 HOSPITAL DRIVE SUITE G-04
CLINTON MD
20735-3134
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-8888
  • Fax: 301-868-0409
Mailing address:
  • Phone: 301-856-3019
  • Fax: 301-856-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JANE RAYMOND
Title or Position: VICE PRESIDENT
Credential:
Phone: 301-856-3019