Healthcare Provider Details

I. General information

NPI: 1497669345
Provider Name (Legal Business Name): PHYSICIAN ASSISTANT SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BROWNS HILL CT
MIDLOTHIAN VA
23114-9510
US

IV. Provider business mailing address

250 BROWNS HILL CT
MIDLOTHIAN VA
23114-9510
US

V. Phone/Fax

Practice location:
  • Phone: 248-765-3499
  • Fax:
Mailing address:
  • Phone: 248-765-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ASHOK GOWDA
Title or Position: CO-OWNER
Credential:
Phone: 248-765-3499