Healthcare Provider Details

I. General information

NPI: 1750322467
Provider Name (Legal Business Name): TWIN ARCH SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 THOMAS JOHNSON DR SUITE 3
FREDERICK MD
21702-4398
US

IV. Provider business mailing address

1001 TWIN ARCH RD
MOUNT AIRY MD
21771-4138
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-9669
  • Fax: 301-695-0346
Mailing address:
  • Phone: 301-829-5111
  • Fax: 301-695-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberA1285
License Number StateMD

VIII. Authorized Official

Name: DR. KENNETH JAMES BENJAMIN
Title or Position: OWNER
Credential:
Phone: 301-695-9669