Healthcare Provider Details

I. General information

NPI: 1033635206
Provider Name (Legal Business Name): MEDSTAR SURGERY CENTER AT TIMONIUM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 GREENSPRING DR
TIMONIUM MD
21093-3112
US

IV. Provider business mailing address

2118 GREENSPRING DR STE 300
TIMONIUM MD
21093-3112
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-5671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SPENCER RUBINSTEIN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 410-252-5671