Organization Name: | MEDSTAR SURGERY CENTER AT BRANDYWINE, LLC |
NPI Number: | 1053779116 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENETHA D MORAN (OFFICER / AUTHORIZED OFFICIAL) |
Mailing Address: | 13950 Brandywine Road Suite 100 Brandywine |
State: | MD US |
Postal Code: | 20613 |
Phone Number: | 9727633893 |
Fax Number: | 9726926745 |
NPI Enumeration Date: | 02/04/2016 |
NPI Last Update Date: | 02/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |