MEDICARE: COLON RECTAL SURGICAL ASSOCIATES, 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	208C00000X	Colon & Rectal Surgery Physician

General Provider Information

NPI Number	:	1831150234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLON RECTAL SURGICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	4801 DORSEY HALL DR STE 216
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7749
Country	:	US
Telephone Number	:	410-730-1712
Fax Number	:	410-730-1713

Provider Business Practice Location Address
First Line	:	4801 DORSEY HALL DR STE 216
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7749
Country	:	US
Telephone Number	:	410-730-1712
Fax Number	:	410-730-1713

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. JAMES JOSEPH ZALUCKI
Credential	:	MD
Telephone Number	:	410-707-1586

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	12/11/2018

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