Healthcare Provider Details

I. General information

NPI: 1518090406
Provider Name (Legal Business Name): HOTCHKISS SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12070 OLD LINE CTR SUITE 110
WALDORF MD
20602-2513
US

IV. Provider business mailing address

12070 OLD LINE CTR SUITE 110
WALDORF MD
20602-2513
US

V. Phone/Fax

Practice location:
  • Phone: 301-843-9581
  • Fax:
Mailing address:
  • Phone: 301-843-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1420
License Number StateMD

VIII. Authorized Official

Name: DR. LARRY STEPHAN HOTCHKISS
Title or Position: OWNER
Credential: D.P.M.
Phone: 301-843-9581