Healthcare Provider Details

I. General information

NPI: 1821106907
Provider Name (Legal Business Name): ENDOSCOPY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 OSLER DR SUITE 108
TOWSON MD
21204-7673
US

IV. Provider business mailing address

7401 OSLER DR SUITE 108
TOWSON MD
21204-7673
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-8331
  • Fax: 410-821-8339
Mailing address:
  • Phone: 410-821-8331
  • Fax: 410-821-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1201
License Number StateMD

VII. Legacy identifiers

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

# 1
Identifier218300500
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: MRS. BILIE PAYNE
Title or Position: CHIEF MANAGER OF LLC
Credential:
Phone: 615-665-1283