Healthcare Provider Details

I. General information

NPI: 1033437272
Provider Name (Legal Business Name): ENDOSCOPIC ASSOCIATES OF WALDORF PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 PEMBROOKE SQ SUITE 202
WALDORF MD
20603-4808
US

IV. Provider business mailing address

12070 OLD LINE CTR STE 200
WALDORF MD
20602-2503
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-8035
  • Fax: 301-645-5229
Mailing address:
  • Phone: 301-645-8035
  • Fax: 301-645-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH R MURPHY
Title or Position: PARTNER
Credential: M.D.
Phone: 301-645-8035