Healthcare Provider Details

I. General information

NPI: 1609375682
Provider Name (Legal Business Name): LUTHERVILLE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 E JOPPA RD
TOWSON MD
21286
US

IV. Provider business mailing address

1609 E JOPPA RD
TOWSON MD
21286-2122
US

V. Phone/Fax

Practice location:
  • Phone: 410-834-5600
  • Fax:
Mailing address:
  • Phone: 410-834-5600
  • Fax: 410-834-5616

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: MARCY LONG
Title or Position: BUSINESS OFFICE MANAGER
Credential: CBOM, PMEC
Phone: 410-834-5600