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General NPI Number Information
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NPI Number | 1063445179
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Entity Type | Organization
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Legal Business Name | WHITESQUARE VASCULAR SURGERY PA
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 9114 PHILADELPHIA ROAD SUITE 308
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City | BALTIMORE
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State | MD
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Zip | 21237
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Country | US
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Telephone | 410-682-4433
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Fax | 410-682-4051
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Provider Business Mailing Address
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Address Line | 9114 PHILADELPHIA ROAD SUITE 308
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City | BALTIMORE
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State | MD
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Zip | 21237
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Country | US
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Telephone | 410-682-4433
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Fax | 410-682-4051
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE J JABAJI
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Credential | M D
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Telephone | 410-682-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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