Healthcare Provider Details

I. General information

NPI: 1124443809
Provider Name (Legal Business Name): POOLE ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 WASHINGTON RD SUITE 218
WESTMINSTER MD
21157-5750
US

IV. Provider business mailing address

826 WASHINGTON RD SUITE 218
WESTMINSTER MD
21157-5750
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-9004
  • Fax: 410-871-9006
Mailing address:
  • Phone: 410-871-9004
  • Fax: 410-871-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberD0036409
License Number StateMD

VIII. Authorized Official

Name: NEEL KAMAL
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 410-871-9004