=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477098127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN MARYLAND GENERAL SURGERY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2017
-----------------------------------------------------
Last Update Date | 06/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3261 OLD WASHINGTON RD SUITE 1012
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-843-9060
-----------------------------------------------------
Fax | 301-645-3092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3261 OLD WASHINGTON RD SUITE 1012
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-843-9060
-----------------------------------------------------
Fax | 301-645-3092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. ABDEL AZIZ BASHA EL SAID
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 301-843-9060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | D0034140
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------