Healthcare Provider Details

I. General information

NPI: 1366511057
Provider Name (Legal Business Name): WHITE FLINT SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20528 BOLAND FARM RD STE 210
GERMANTOWN MD
20876-4038
US

IV. Provider business mailing address

15001 SHADY GROVE ROAD SUITE 120
ROCKVILLE MD
20850-6352
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-0070
  • Fax: 301-251-0071
Mailing address:
  • Phone: 301-251-0070
  • Fax: 301-251-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1317
License Number StateMD

VIII. Authorized Official

Name: JAYESH DAYAL
Title or Position: PRESIDENT
Credential: MD
Phone: 301-251-0070