Healthcare Provider Details

I. General information

NPI: 1407967706
Provider Name (Legal Business Name): BAYSIDE SURGICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8023 RITCHIE HWY
PASADENA MD
21122-7107
US

IV. Provider business mailing address

8023 RITCHIE HWY
PASADENA MD
21122-7107
US

V. Phone/Fax

Practice location:
  • Phone: 410-761-4190
  • Fax: 410-761-0265
Mailing address:
  • Phone: 410-761-4190
  • Fax: 410-761-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1167
License Number StateMD

VIII. Authorized Official

Name: DR. ROSS SAMUEL COHEN
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 410-761-4190