Provider Demographics
NPI:1306924170
Name:DELMAR SURGICAL CENTER LLC
Entity type:Organization
Organization Name:DELMAR SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-320-3040
Mailing Address - Street 1:103 CHESAPEAKE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6313
Mailing Address - Country:US
Mailing Address - Phone:410-392-6133
Mailing Address - Fax:410-392-4958
Practice Address - Street 1:103 CHESAPEAKE BLVD STE C
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6313
Practice Address - Country:US
Practice Address - Phone:410-392-6133
Practice Address - Fax:410-392-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036586261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD074ZOtherMEDICARE