Healthcare Provider Details

I. General information

NPI: 1730791104
Provider Name (Legal Business Name): CAPITAL REGION SURGICAL ASSISTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 HILLSIDE LAKE TER APT 605
GAITHERSBURG MD
20878-5242
US

IV. Provider business mailing address

903 HILLSIDE LAKE TER APT 605
GAITHERSBURG MD
20878-5242
US

V. Phone/Fax

Practice location:
  • Phone: 443-910-0033
  • Fax:
Mailing address:
  • Phone: 443-910-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. NOAH HANKERSON
Title or Position: OWNER
Credential: CSA, CSFA, LSA
Phone: 443-910-0033