Provider Demographics
NPI:1104161082
Name:MASSACHUSETTS AVENUE SURGICAL CONSULTANTS LLC
Entity type:Organization
Organization Name:MASSACHUSETTS AVENUE SURGICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-263-0800
Mailing Address - Street 1:6400 GOLDSBORO RD STE 400
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5846
Mailing Address - Country:US
Mailing Address - Phone:301-263-0800
Mailing Address - Fax:301-263-0820
Practice Address - Street 1:6400 GOLDSBORO RD STE 400
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-5846
Practice Address - Country:US
Practice Address - Phone:301-263-0800
Practice Address - Fax:301-263-0820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASSACHUSETTS AVENUE CONSULTING SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty