Healthcare Provider Details

I. General information

NPI: 1164905824
Provider Name (Legal Business Name): SURGICAL FOCUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12509 VIEWSIDE DR
NORTH POTOMAC MD
20878-3580
US

IV. Provider business mailing address

12509 VIEWSIDE DR
NORTH POTOMAC MD
20878-3580
US

V. Phone/Fax

Practice location:
  • Phone: 215-518-2138
  • Fax:
Mailing address:
  • Phone: 215-518-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEROME J UPCHURCH
Title or Position: SURGICAL ASSISTANT
Credential: SA-C, CSFA, L-SA
Phone: 215-518-2138