Healthcare Provider Details

I. General information

NPI: 1609871680
Provider Name (Legal Business Name): LAUREL MD ENDOSCOPY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD STE 230
LAUREL MD
20707-5263
US

IV. Provider business mailing address

1A BURTON HILLS BLVD # L&C
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-5500
  • Fax: 301-604-5956
Mailing address:
  • Phone: 615-240-3820
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1099R
License Number StateMD

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283