Provider Demographics
NPI:1427521780
Name:ELDERSBURG SURGERY CENTER
Entity type:Organization
Organization Name:ELDERSBURG SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-795-2155
Mailing Address - Street 1:1010 LIBERTY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7949
Mailing Address - Country:US
Mailing Address - Phone:410-795-2155
Mailing Address - Fax:410-795-2154
Practice Address - Street 1:1010 LIBERTY RD STE 100
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-7949
Practice Address - Country:US
Practice Address - Phone:410-795-2155
Practice Address - Fax:410-795-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical