Healthcare Provider Details

I. General information

NPI: 1528153111
Provider Name (Legal Business Name): MECHANICSVILLE AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28227 THREE NOTCH ROAD
MECHANICSVILLE MD
20659
US

IV. Provider business mailing address

28227 THREE NOTCH ROAD
MECHANICSVILLE MD
20659
US

V. Phone/Fax

Practice location:
  • Phone: 301-884-8161
  • Fax: 301-475-7039
Mailing address:
  • Phone: 301-884-8161
  • Fax: 301-475-7039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1402
License Number StateMD

VIII. Authorized Official

Name: KRISHNA P JAYARAMAN
Title or Position: PRESIDENT
Credential:
Phone: 301-884-8161