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General NPI Number Information
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NPI Number | 1427521780
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Entity Type | Organization
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Legal Business Name | ELDERSBURG SURGERY CENTER
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 1010 LIBERTY RD STE 100
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City | ELDERSBURG
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State | MD
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Zip | 21784-7949
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Country | US
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Telephone | 410-795-2155
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Fax | 410-795-2154
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Provider Business Mailing Address
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Address Line | 1010 LIBERTY RD STE 100
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City | ELDERSBURG
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State | MD
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Zip | 21784-7949
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Country | US
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Telephone | 410-795-2155
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Fax | 410-795-2154
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN LEWIS
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Credential | DPM
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Telephone | 410-795-2155
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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 |
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License Number State |
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