Healthcare Provider Details

I. General information

NPI: 1871529180
Provider Name (Legal Business Name): CAPITAL AREA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 THOMAS JOHNSON DR STE 190
FREDERICK MD
21702-4509
US

IV. Provider business mailing address

141 THOMAS JOHNSON DR STE 190
FREDERICK MD
21702-4509
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-4403
  • Fax: 301-668-4406
Mailing address:
  • Phone: 301-668-4403
  • Fax: 301-668-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1349
License Number StateMD

VIII. Authorized Official

Name: DR. MRUTHYUNJAYA GONCHIGAR
Title or Position: PARTNER
Credential:
Phone: 301-668-4403