Healthcare Provider Details

I. General information

NPI: 1710952841
Provider Name (Legal Business Name): ANDOCHICK SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 THOMAS JOHNSON COURT SUITE B
FREDERICK MD
21702
US

IV. Provider business mailing address

81 THOMAS JOHNSON COURT SUITE B
FREDERICK MD
21702
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-3070
  • Fax: 240-215-3071
Mailing address:
  • Phone: 240-215-3070
  • Fax: 240-215-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number208200000X
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT E. ANDOCHICK
Title or Position: OWNER-CHAIRMAN
Credential: M.D.
Phone: 301-620-4200