Healthcare Provider Details

I. General information

NPI: 1689986879
Provider Name (Legal Business Name): DEER POINTE SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2010
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 S SALISBURY BLVD
SALISBURY MD
21801-5429
US

IV. Provider business mailing address

1675 WOODBROOKE DR
SALISBURY MD
21804-8502
US

V. Phone/Fax

Practice location:
  • Phone: 410-341-9002
  • Fax: 410-341-9006
Mailing address:
  • Phone: 410-341-9002
  • Fax: 410-341-9006

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: PASQUALE PETRERA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 410-749-4154