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General NPI Number Information
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NPI Number | 1548406960
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES, CHARTERED
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 12070 OLD LINE CTR SUITE 306
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City | WALDORF
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State | MD
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Zip | 20602-2513
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Country | US
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Telephone | 301-868-8485
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Fax | 301-868-0638
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Provider Business Mailing Address
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Address Line | 7501 SURRATTS RD SUITE 303
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City | CLINTON
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State | MD
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Zip | 20735-3362
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Country | US
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Telephone | 301-868-8485
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Fax | 301-868-0638
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Authorized Official
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Title or Position | CREDENTIALING/CONTRACTS MANAGER
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Name | MICHELLE BURTON
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Credential |
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Telephone | 301-868-8485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0003134
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R119098
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | D0059944
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | D26021
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | H0061922
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License Number State | MD
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Taxonomy #6
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | D24644
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License Number State | MD
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