Organization Name: | UNIVERSITY OF MARYLAND SHORE SURGERY CENTER AT QUEENSTOWN, LLC |
NPI Number: | 1174942635 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KENNETH D KOZEL (PRESIDENT/CEO) |
Mailing Address: | 125 Shoreway Dr Queenstown |
State: | MD US |
Postal Code: | 216581680 |
Phone Number: | 4108221000 |
Fax Number: | |
NPI Enumeration Date: | 04/14/2014 |
NPI Last Update Date: | 04/14/2014 |
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: |