Healthcare Provider Details

I. General information

NPI: 1962595942
Provider Name (Legal Business Name): ENDOSCOPIC SURGICAL CENTRE OF MARYLAND 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

10801 LOCKWOOD DR SUITE 110
SILVER SPRING MD
20901-1556
US

IV. Provider business mailing address

10801 LOCKWOOD DR SUITE 110
SILVER SPRING MD
20901-1556
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-5110
  • Fax: 301-593-6269
Mailing address:
  • Phone: 301-593-5110
  • Fax: 301-593-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1226
License Number StateMD

VIII. Authorized Official

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