Healthcare Provider Details

I. General information

NPI: 1710932207
Provider Name (Legal Business Name): CENTER FOR UNIVERSAL SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX CT. SUITE 205
FREDERICK MD
21703-8655
US

IV. Provider business mailing address

6550 MERCANTILE DR E SUITE 104
FREDERICK MD
21703-7655
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-0888
  • Fax: 301-668-0999
Mailing address:
  • Phone: 301-668-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberD0053489
License Number StateMD

VIII. Authorized Official

Name: LAURA L.
Title or Position: MANAGER
Credential:
Phone: 301-668-0888