Healthcare Provider Details

I. General information

NPI: 1104639509
Provider Name (Legal Business Name): NSPC SURGERY CENTER OF FREDERICK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DR STE C
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

5280 CORPORATE DR STE C250
FREDERICK MD
21703-8508
US

V. Phone/Fax

Practice location:
  • Phone: 301-620-0012
  • Fax: 301-620-9687
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YESHVANT NAVALGUND
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 855-836-7246