Healthcare Provider Details

I. General information

NPI: 1255577045
Provider Name (Legal Business Name): MAPLE LAWN SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2008
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 MAPLE LAWN BLVD SUITE 110
FULTON MD
20759-2565
US

IV. Provider business mailing address

7625 MAPLE LAWN BLVD SUITE 110
FULTON MD
20759-2565
US

V. Phone/Fax

Practice location:
  • Phone: 443-977-0085
  • Fax:
Mailing address:
  • Phone: 443-977-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: OFFICER/AUTHORIZED OFFICAL
Credential:
Phone: 203-609-1168