Healthcare Provider Details

I. General information

NPI: 1811134695
Provider Name (Legal Business Name): OLNEY CENTER FOR RECONSTRUCTIVE SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 PRINCE PHILIP DR SUITE 204
OLNEY MD
20832-1513
US

IV. Provider business mailing address

56 THOMAS JOHNSON DR SUITE 10
FREDERICK MD
21702-4599
US

V. Phone/Fax

Practice location:
  • Phone: 301-698-9999
  • Fax: 301-698-9699
Mailing address:
  • Phone: 301-570-8896
  • Fax: 301-698-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberD44403
License Number StateMD

VIII. Authorized Official

Name: JAMES S ALBERTOLI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-698-9999