Provider Demographics
NPI:1285149567
Name:GEMINI ASC ELKRIDGE LLC
Entity type:Organization
Organization Name:GEMINI ASC ELKRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-796-1577
Mailing Address - Street 1:2702 BACK ACRE CIR STE 290B
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7769
Mailing Address - Country:US
Mailing Address - Phone:410-796-1577
Mailing Address - Fax:301-703-8886
Practice Address - Street 1:6816 DEERPATH RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6200
Practice Address - Country:US
Practice Address - Phone:410-796-1577
Practice Address - Fax:301-703-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical