Provider Demographics
NPI:1962595942
Name:ENDOSCOPIC SURGICAL CENTRE OF MARYLAND LLC
Entity type:Organization
Organization Name:ENDOSCOPIC SURGICAL CENTRE OF MARYLAND 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 1:10801 LOCKWOOD DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1556
Mailing Address - Country:US
Mailing Address - Phone:301-593-5110
Mailing Address - Fax:301-593-6269
Practice Address - Street 1:10801 LOCKWOOD DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1556
Practice Address - Country:US
Practice Address - Phone:301-593-5110
Practice Address - Fax:301-593-6269
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
MDA1226261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6800172OtherUNITEDHEALTHCARE NUMBER
MD60699901OtherBC/BS OF MARYLAND
PJ9OtherBC/BS NATIONALCAPITALAREA
1054141OtherKAISER PROVIDER NUMBER
483056OtherNCPPO
247638OtherMAMSI PROVIDER NUMBER
483056OtherNCPPO
1054141OtherKAISER PROVIDER NUMBER