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General NPI Number Information
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NPI Number | 1396897351
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Entity Type | Organization
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Legal Business Name | THE ADULT & PEDIATRIC UROLOGY SURGERY CENTER LLC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 3455 WILKENS AVE SUITE 100
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City | BALTIMORE
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State | MD
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Zip | 21229-5213
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Country | US
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Telephone | 410-646-0330
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Fax | 410-644-6182
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Provider Business Mailing Address
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Address Line | 3455 WILKENS AVE SUITE 100
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City | BALTIMORE
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State | MD
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Zip | 21229-5213
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Country | US
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Telephone | 410-646-0330
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Fax | 410-644-6182
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRIDGET MASTROUNNI
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Credential |
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Telephone | 410-646-0331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A1408
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License Number State | MD
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