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General NPI Number Information
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NPI Number | 1750775268
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Entity Type | Organization
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Legal Business Name | SOUTHERN MARYLAND ENDOSCOPY CENTER ANESTHESIA
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 7700 OLD BRANCH AVE SUITE A103
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City | CLINTON
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State | MD
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Zip | 20735-1628
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Country | US
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Telephone | 301-877-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 OLD BRANCH AVE SUITE A103
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City | CLINTON
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State | MD
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Zip | 20735-1628
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Country | US
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Telephone | 301-877-4140
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAMES S CHESLEY JR.
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Credential | MD
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Telephone | 301-877-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 207RG0100X
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License Number State | MD
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