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General NPI Number Information
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NPI Number | 1144608514
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Entity Type | Organization
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Legal Business Name | MDP SURGERY CENTER
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 216 E PULASKI HWY 120
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City | ELKTON
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State | MD
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Zip | 21921-6497
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Country | US
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Telephone | 443-490-4000
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Fax | 443-484-2831
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Provider Business Mailing Address
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Address Line | PO BOX 404
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City | BEL AIR
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State | MD
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Zip | 21014-0404
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Country | US
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Telephone | 443-490-4000
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Fax | 443-484-2831
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Authorized Official
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Title or Position | CEO
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Name | DR. BENJAMIN LEE
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Credential | M.D
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Telephone | 443-490-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | D0057974
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License Number State | MD
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