Healthcare Provider Details

I. General information

NPI: 1275710436
Provider Name (Legal Business Name): HANOVER PARKWAY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 HANOVER DRIVE SUITE 204
GREENBELT MD
20770
US

IV. Provider business mailing address

7300 HANOVER DRIVE SUITE 204
GREENBELT MD
20770
US

V. Phone/Fax

Practice location:
  • Phone: 301-220-2333
  • Fax: 301-220-2339
Mailing address:
  • Phone: 301-220-2333
  • Fax: 301-220-2339

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: DR. HADDIS TESFAYOHANNES HAGOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-220-2333