Healthcare Provider Details

I. General information

NPI: 1679207211
Provider Name (Legal Business Name): SUMMIT BRACHYTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19851 OBSERVATION DR STE 445
GERMANTOWN MD
20876-4139
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-9660
  • Fax:
Mailing address:
  • Phone: 559-385-3817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SANFORD SIEGEL
Title or Position: AO
Credential: MD
Phone: 410-581-1600