1558762906 NPI number — SURGICAL ASSOCIATES OF MARYLAND

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558762906 NPI number — SURGICAL ASSOCIATES OF MARYLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ASSOCIATES OF MARYLAND
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558762906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 428
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21922-0428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-398-0590
Provider Business Mailing Address Fax Number:
443-485-6531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E PULASKI HWY
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21921-6737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-398-0590
Provider Business Practice Location Address Fax Number:
443-485-6531
Provider Enumeration Date:
09/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
AWAN
Authorized Official First Name:
MARYAM
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MBR
Authorized Official Telephone Number:
410-398-0590

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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