Healthcare Provider Details

I. General information

NPI: 1467558429
Provider Name (Legal Business Name): NEUROCARE AMBULATORY SURGERY CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MEDICAL PARK DR SUITE 307
SILVER SPRING MD
20902-4053
US

IV. Provider business mailing address

2101 MEDICAL PARK DR SUITE 307
SILVER SPRING MD
20902-4053
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-0833
  • Fax: 301-754-0388
Mailing address:
  • Phone: 301-754-0833
  • Fax: 301-754-0388

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: DR. DAMIREZ T FOSSETT
Title or Position: DIRECTOR
Credential: M.D.
Phone: 301-754-0833