Healthcare Provider Details

I. General information

NPI: 1861447401
Provider Name (Legal Business Name): SURGICAL ASSOCIATES, CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 PEMBROOKE SQ SUITE 213
WALDORF MD
20603-4808
US

IV. Provider business mailing address

7501 SURRATTS RD SUITE 303
CLINTON MD
20735-3362
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-8320
  • Fax: 301-645-8663
Mailing address:
  • Phone: 301-868-8485
  • Fax: 301-868-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RODEEN RAHBAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 240-427-1630