| Organization Name: | THE WALDORF ENDOSCOPY ASC, LLC |
| NPI Number: | 1003889379 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILLIP CLENDENIN (PRESIDENT) |
| Mailing Address: | 3510 Old Washington Rd Waldorf |
| State: | MD US |
| Postal Code: | 206023233 |
| Phone Number: | 3016385354 |
| Fax Number: | 3018435184 |
| NPI Enumeration Date: | 02/08/2006 |
| NPI Last Update Date: | 12/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | A1062 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |