MEDICARE: WHITE FLINT SURGERY 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	261QA1903X	Ambulatory Surgical Clinic/Center	A1317	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366511057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE FLINT SURGERY LLC

Provider Business Mailing Address
First Line	:	15001 SHADY GROVE ROAD SUITE 120
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-6352
Country	:	US
Telephone Number	:	301-251-0070
Fax Number	:	301-251-0071

Provider Business Practice Location Address
First Line	:	20528 BOLAND FARM RD STE 210
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-4038
Country	:	US
Telephone Number	:	301-251-0070
Fax Number	:	301-251-0071

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAYESH DAYAL
Credential	:	MD
Telephone Number	:	301-251-0070

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	11/15/2023

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Directions to “WHITE FLINT SURGERY LLC ” Practice Location

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