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General NPI Number Information
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NPI Number | 1770572307
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Entity Type | Organization
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Legal Business Name | BETHESDA SURGERY CENTER, LLC
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 10215 FERNWOOD RD SUITE 412
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City | BETHESDA
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State | MD
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Zip | 20817-1106
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Country | US
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Telephone | 301-530-6100
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Fax | 301-530-6104
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Provider Business Mailing Address
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Address Line | 10215 FERNWOOD RD SUITE 412
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City | BETHESDA
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State | MD
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Zip | 20817-1106
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Country | US
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Telephone | 301-530-6100
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Fax | 301-530-6104
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ROGER J OLDHAM
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Credential | M.D.
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Telephone | 301-530-6100
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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 | A1130
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License Number State | MD
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