Healthcare Provider Details

I. General information

NPI: 1780036996
Provider Name (Legal Business Name): MARYLAND SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E PULASKI HWY
ELKTON MD
21921-6737
US

IV. Provider business mailing address

PO BOX 1165
MIDDLETOWN DE
19709-7165
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-0590
  • Fax: 302-595-3149
Mailing address:
  • Phone: 410-398-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MARYAM AWAN
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 410-398-0590