Provider Demographics
NPI:1427428440
Name:GYN SURGICENTER ROCKVILLE PC
Entity type:Organization
Organization Name:GYN SURGICENTER ROCKVILLE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OR MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALINAO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:443-574-4125
Mailing Address - Street 1:3206 TOWER OAKS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4254
Mailing Address - Country:US
Mailing Address - Phone:240-669-3134
Mailing Address - Fax:240-669-3053
Practice Address - Street 1:3206 TOWER OAKS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4254
Practice Address - Country:US
Practice Address - Phone:240-669-3134
Practice Address - Fax:240-669-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical