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General NPI Number Information
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NPI Number | 1376839092
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Entity Type | Organization
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Legal Business Name | BALTIMORE SURGICAL, LLC
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 2411 W BELVEDERE AVE STE 302
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City | BALTIMORE
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State | MD
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Zip | 21215-5228
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Country | US
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Telephone | 410-542-1722
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5381
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City | BALTIMORE
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State | MD
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Zip | 21209-0381
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Country | US
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Telephone | 615-525-1626
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | YASSAR KHALIL YOUSSEF
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Credential | M.D.
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Telephone | 410-542-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D54931
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D0071504
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License Number State | MD
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