Healthcare Provider Details

I. General information

NPI: 1447319603
Provider Name (Legal Business Name): NORTHERN BALTIMORE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WEST RD STE 229
TOWSON MD
21204-2316
US

IV. Provider business mailing address

110 WEST RD STE 229
TOWSON MD
21204
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-3131
  • Fax: 410-825-4037
Mailing address:
  • Phone: 410-825-3131
  • Fax: 410-825-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1187
License Number StateMD

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. OLIVER J CHAMBERLAIN
Title or Position: OWNER, MANAGER
Credential:
Phone: 410-825-3131