Healthcare Provider Details

I. General information

NPI: 1023349909
Provider Name (Legal Business Name): PICCARD SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2010
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 PICCARD DR STE 102
ROCKVILLE MD
20850-4330
US

IV. Provider business mailing address

1330 PICCARD DR STE 102
ROCKVILLE MD
20850-4330
US

V. Phone/Fax

Practice location:
  • Phone: 301-208-7350
  • Fax: 301-208-7355
Mailing address:
  • Phone: 301-208-7350
  • Fax: 301-208-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 203-609-1168