=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902991979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTERN MARYLAND EYE SURGICAL CENTER,PHILIP MCGANN, M.D., PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 03/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1003 W 7TH ST SUITE 400
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701-4106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-662-3721
-----------------------------------------------------
Fax | 301-698-8164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1003 W 7TH ST SUITE 400
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701-4106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-662-3721
-----------------------------------------------------
Fax | 301-698-8164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. PHILIP JOHN MCGANN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 301-662-3721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number | D00029921
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------