Organization · NPI-2

9106 Philadelphia Road Ambulatory Surgery Center LLC

Clinic/Center, Ambulatory Surgical · Baltimore, MD

NPI number1942485305
StatusActive
Last updated in NPPESApr 16, 2021

Details

NPI
1942485305
Entity type
Organization (NPI-2)
Legal business name
9106 Philadelphia Road Ambulatory Surgery Center LLC
Organization subpart
No
Enumeration date
Jan 4, 2008
Certification date
Apr 16, 2021
Last updated
Apr 16, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QA1903X Clinic/Center, Ambulatory Surgical––Yes
261Q00000X Clinic/Center––

Practice location

9106 Philadelphia Rd
Suite 306
Baltimore, MD 21237

Phone 410-687-2656 · Fax 410-687-3805

Mailing address

9106 Philadelphia Rd
Suite 306
Baltimore, MD 21237

Phone 410-687-2656 · Fax 410-687-3805

Authorized official

Gabriel Martinez
Owner/MD
4106872656

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