Healthcare Provider Details

I. General information

NPI: 1508199720
Provider Name (Legal Business Name): NEWBRIDGE SURGERY CENTER AT FREDERICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 THOMAS JOHNSON DR SUITE 215
FREDERICK MD
21702-4397
US

IV. Provider business mailing address

196 THOMAS JOHNSON DR SUITE 215
FREDERICK MD
21702-4397
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-9988
  • Fax: 301-668-9977
Mailing address:
  • Phone: 301-668-9988
  • Fax: 301-576-8064

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: MRUTHYUNJAYA GONCHIGAR
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 301-668-9988