Provider Demographics
NPI:1962734814
Name:CHEVY CHASE SURGICAL PARTNERS LLC
Entity type:Organization
Organization Name:CHEVY CHASE SURGICAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-912-2206
Mailing Address - Street 1:6430 ROCKLEDGE DR STE 510
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7893
Mailing Address - Country:US
Mailing Address - Phone:240-912-2206
Mailing Address - Fax:301-530-1435
Practice Address - Street 1:6430 ROCKLEDGE DR STE 510
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7893
Practice Address - Country:US
Practice Address - Phone:240-912-2206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC00815363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC230718ZDJHMedicare PIN