Healthcare Provider Details

I. General information

NPI: 1528151586
Provider Name (Legal Business Name): ENDOSCOPIC SURGICAL CENTRE OF MARYLAND-NORTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 SHADY GROVE RD SUITE 300
ROCKVILLE MD
20850-6340
US

IV. Provider business mailing address

15005 SHADY GROVE RD SUITE 300
ROCKVILLE MD
20850-6340
US

V. Phone/Fax

Practice location:
  • Phone: 310-762-1280
  • Fax: 301-762-5678
Mailing address:
  • Phone: 310-762-1280
  • Fax: 301-762-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1368
License Number StateMD

VIII. Authorized Official

Name: MR. CHRISTOPHER A HOLDEN
Title or Position: CHIEF MANAGER OF LLC
Credential:
Phone: 615-665-1283