Healthcare Provider Details

I. General information

NPI: 1356007116
Provider Name (Legal Business Name): USACS CRITICAL CARE MEDICINE SERVICES EAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 MEDICAL CENTER DR
ROCKVILLE MD
20850-3357
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 844-474-4019
  • Fax:
Mailing address:
  • Phone: 844-474-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DOMINIC BAGNOLI JR.
Title or Position: EXECUTIVE CHAIRMAN
Credential:
Phone: 330-994-4409