Provider Demographics
NPI:1528151586
Name:ENDOSCOPIC SURGICAL CENTRE OF MARYLAND-NORTH LLC
Entity type:Organization
Organization Name:ENDOSCOPIC SURGICAL CENTRE OF MARYLAND-NORTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:15005 SHADY GROVE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6340
Mailing Address - Country:US
Mailing Address - Phone:310-762-1280
Mailing Address - Fax:301-762-5678
Practice Address - Street 1:15005 SHADY GROVE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6340
Practice Address - Country:US
Practice Address - Phone:310-762-1280
Practice Address - Fax:301-762-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1368261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
522576OtherNCPPO
MD237001OtherKAISER INSURANCE
MD6800326OtherUNITEDHEALTHCARE PROVIDER
PY6OtherBC/BS OF DC
236707OtherMAMSI PROVIDER NUMBER
MD61779101OtherBC/BS OF MARYLAND
522576OtherNCPPO
MD6800326OtherUNITEDHEALTHCARE PROVIDER