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General NPI Number Information
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NPI Number | 1992174221
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Entity Type | Organization
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Legal Business Name | ELITE SURGICAL SERVICES, LLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 10518 TANAGER LN
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City | POTOMAC
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State | MD
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Zip | 20854-6315
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Country | US
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Telephone | 240-603-0445
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Fax |
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Provider Business Mailing Address
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Address Line | 10518 TANAGER LN
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City | POTOMAC
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State | MD
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Zip | 20854-6315
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Country | US
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Telephone | 240-603-0445
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE RESTA III
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Credential | M.D.
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Telephone | 240-603-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | D65116
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License Number State | MD
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