Healthcare Provider Details

I. General information

NPI: 1396089868
Provider Name (Legal Business Name): WASHINGTON INSTITUTE OF SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13116 BRUSHWOOD WAY
POTOMAC MD
20854-1025
US

IV. Provider business mailing address

PO BOX 60428
POTOMAC MD
20859-0428
US

V. Phone/Fax

Practice location:
  • Phone: 571-275-9279
  • Fax: 301-519-3797
Mailing address:
  • Phone: 571-275-9279
  • Fax: 301-519-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD54052
License Number StateMD

VIII. Authorized Official

Name: DR. MOHAMMED M.H. KALAN
Title or Position: OWNER
Credential: M.D.,
Phone: 571-275-9279