Healthcare Provider Details

I. General information

NPI: 1700742913
Provider Name (Legal Business Name): MALVERN ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CENTRAL AVE STE LL
MALVERN PA
19355-3265
US

IV. Provider business mailing address

7120 MINSTREL WAY STE 100
COLUMBIA MD
21045-5274
US

V. Phone/Fax

Practice location:
  • Phone: 410-290-6677
  • Fax: 410-290-6676
Mailing address:
  • Phone: 410-290-6677
  • Fax: 410-290-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ZACHARY JONES
Title or Position: CEO
Credential:
Phone: 410-290-6677