Healthcare Provider Details

I. General information

NPI: 1922837517
Provider Name (Legal Business Name): ANNAPOLIS ENT SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL RD STE 101
PRINCE FREDERICK MD
20678-4029
US

IV. Provider business mailing address

130 HOSPITAL RD STE 101
PRINCE FREDERICK MD
20678-4029
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-6975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: ERIN BEZEK
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 410-266-6267