Provider Demographics
NPI:1285944504
Name:NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK, LLC
Entity type:Organization
Organization Name:NEWBRIDGE SURGERY CENTER AT PRINCE FREDERICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MRUTHYUNJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONCHIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-461-6687
Mailing Address - Street 1:196 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4397
Mailing Address - Country:US
Mailing Address - Phone:301-668-9988
Mailing Address - Fax:301-668-9977
Practice Address - Street 1:80 SHERRY LN STE 101B
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3232
Practice Address - Country:US
Practice Address - Phone:410-414-9229
Practice Address - Fax:410-414-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229359Medicare PIN