Organization Name: | PENINSULA ENDOSCOPY CENTER, LLC |
NPI Number: | 1023162013 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KOTA L CHANDRASEKHARA (PRESIDENT) |
Mailing Address: | 9315 Ocean Highway Delmar |
State: | MD US |
Postal Code: | 218752339 |
Phone Number: | 4108969005 |
Fax Number: | 4108969337 |
NPI Enumeration Date: | 01/23/2007 |
NPI Last Update Date: | 09/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | 014352 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |