Healthcare Provider Details

I. General information

NPI: 1649330259
Provider Name (Legal Business Name): RFAI SURGERY CENTER HAGERSTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 PROFESSIONAL CT SUITE C
HAGERSTOWN MD
21740-5852
US

IV. Provider business mailing address

PO BOX 269
FREDERICK MD
21705-0269
US

V. Phone/Fax

Practice location:
  • Phone: 301-797-8554
  • Fax: 301-797-8281
Mailing address:
  • Phone: 301-797-9855
  • Fax: 301-797-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1417
License Number StateMD

VIII. Authorized Official

Name: DR. DANIEL DALE MICHAELS
Title or Position: OWNER
Credential: DPM
Phone: 301-797-8554