Healthcare Provider Details

I. General information

NPI: 1477892545
Provider Name (Legal Business Name): METROPOLITAN NEUROSURGERY GROUP ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MERCANTILE LN STE 341
UPPER MARLBORO MD
20774-4331
US

IV. Provider business mailing address

8116 GOOD LUCK RD SUITE 205
LANHAM MD
20706-3502
US

V. Phone/Fax

Practice location:
  • Phone: 301-557-9049
  • Fax: 301-654-9394
Mailing address:
  • Phone: 301-654-9390
  • Fax: 301-654-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberD0044416
License Number StateMD

VIII. Authorized Official

Name: DR. FRASER C HENDERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 301-654-9390