Healthcare Provider Details

I. General information

NPI: 1245427228
Provider Name (Legal Business Name): SUMMIT AMBULATORY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8322 BELLONA AVE SUITE 390
TOWSON MD
21204-2065
US

IV. Provider business mailing address

25 CROSSROADS DR SUITE306
OWINGS MILLS MD
21117-5421
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-6310
  • Fax: 410-825-6320
Mailing address:
  • Phone: 443-738-2872
  • Fax: 443-738-2713

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:

# 1
Identifier800906611
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: DR. SANFORD J SIEGEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-581-1600