Healthcare Provider Details

I. General information

NPI: 1730142415
Provider Name (Legal Business Name): CENTRAL MARYLAND SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 THOMAS JOHNSON DR
FREDERICK MD
21702-4314
US

IV. Provider business mailing address

197 THOMAS JOHNSON DR
FREDERICK MD
21702-4314
US

V. Phone/Fax

Practice location:
  • Phone: 301-624-5510
  • Fax: 301-624-5370
Mailing address:
  • Phone: 301-624-5510
  • Fax: 301-624-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1383
License Number StateMD

VIII. Authorized Official

Name: MS. DEBRA SUE HUFFMAN
Title or Position: VP MANAGED CARE SERVICES
Credential: MHA
Phone: 636-549-2384