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General NPI Number Information
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NPI Number | 1487280871
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Entity Type | Organization
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Legal Business Name | MARYLAND AMBULATORY SURGERY CENTER LLC
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 7501 FORBES BLVD STE 103
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City | LANHAM
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State | MD
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Zip | 20706-6201
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Country | US
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Telephone | 202-498-1125
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Fax | 240-770-0436
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Provider Business Mailing Address
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Address Line | 7501 FORBES BLVD STE 103
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City | LANHAM
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State | MD
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Zip | 20706-6201
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Country | US
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Telephone | 301-850-4401
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Fax | 301-850-4402
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Authorized Official
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Title or Position | OWNER
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Name | TRISTAN SHOCKLEY
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Credential |
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Telephone | 301-850-4401
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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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