Healthcare Provider Details

I. General information

NPI: 1619706207
Provider Name (Legal Business Name): ANNAPOLIS ENT SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MALCOLM DR STE E
WESTMINSTER MD
21157-6160
US

IV. Provider business mailing address

410 MALCOLM DR STE E
WESTMINSTER MD
21157-6160
US

V. Phone/Fax

Practice location:
  • Phone: 410-356-2626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: ERIN BEZEK
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 410-266-6267