MEDICARE: MASSACHUSETTS AVENUE SURGICAL CONSULTANTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1104161082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSACHUSETTS AVENUE SURGICAL CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	6400 GOLDSBORO RD STE 400
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-5846
Country	:	US
Telephone Number	:	301-263-0800
Fax Number	:	301-263-0820

Provider Business Practice Location Address
First Line	:	6400 GOLDSBORO RD STE 400
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-5846
Country	:	US
Telephone Number	:	301-263-0800
Fax Number	:	301-263-0820

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RANDALL GROSS
Credential	:
Telephone Number	:	301-263-0800

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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