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General NPI Number Information
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NPI Number | 1902959190
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Entity Type | Organization
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Legal Business Name | RIVA ROAD SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 2635 RIVA RD STE 118
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7430
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Country | US
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Telephone | 410-571-9595
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Fax | 410-571-9590
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Provider Business Mailing Address
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Address Line | 2635 RIVA RD STE 118
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7430
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Country | US
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Telephone | 410-571-9595
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Fax | 410-571-9590
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | NIKKI CASTEL
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Credential |
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Telephone | 808-772-7818
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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 | PENDING
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License Number State | MD
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