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General NPI Number Information
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NPI Number | 1831214717
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Entity Type | Organization
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Legal Business Name | ADVANCED ENDOSCOPY CENTER OF HOWARD COUNTY, LLC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 8875 CENTRE PARK DR STE D
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City | COLUMBIA
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State | MD
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Zip | 21045-2114
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Country | US
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Telephone | 410-730-1000
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Fax | 410-730-2266
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Provider Business Mailing Address
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Address Line | 8875 CENTRE PARK DR STE D
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City | COLUMBIA
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State | MD
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Zip | 21045-2114
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Country | US
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Telephone | 410-730-1000
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Fax | 410-730-2266
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. RUSSELL O SCHUB
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Credential | DO
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Telephone | 410-730-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | A1343
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License Number State | MD
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