Provider Demographics
NPI:1033524855
Name:KENT ISLAND SURGERY CENTER LLC
Entity Type:Organization
Organization Name:KENT ISLAND SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-571-9000
Mailing Address - Street 1:2661 RIVA RD
Mailing Address - Street 2:BUILDING 100 SUITE 115
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7353
Mailing Address - Country:US
Mailing Address - Phone:443-458-5132
Mailing Address - Fax:443-221-7622
Practice Address - Street 1:1630 MAIN ST
Practice Address - Street 2:SUITE 215A
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2791
Practice Address - Country:US
Practice Address - Phone:410-571-9000
Practice Address - Fax:410-571-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical