Healthcare Provider Details

I. General information

NPI: 1821030156
Provider Name (Legal Business Name): MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 SURRATTS ROAD SUITE 208B
CLINTON MD
20735-3362
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 301-856-1075
  • Fax: 301-856-7815
Mailing address:
  • Phone: 301-856-3019
  • Fax: 301-856-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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