Healthcare Provider Details

I. General information

NPI: 1710115472
Provider Name (Legal Business Name): BALTIMORE WASHINGTON SURGERY CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR SUITE 340
COLUMBIA MD
21044-2858
US

IV. Provider business mailing address

10710 CHARTER DR SUITE 340
COLUMBIA MD
21044-2858
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-1010
  • Fax: 410-997-0807
Mailing address:
  • Phone: 410-997-1010
  • Fax: 410-997-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1497
License Number StateMD

VIII. Authorized Official

Name: DR. DOMENICK COLETTI
Title or Position: DIRECTOR
Credential: M.D., D.D.S.
Phone: 410-997-1010