Provider Demographics
NPI:1104851088
Name:MARYLAND SURGEONS CENTER OF COLUMBIA
Entity Type:Organization
Organization Name:MARYLAND SURGEONS CENTER OF COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:FALCAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-719-0090
Mailing Address - Street 1:P.O. BOX 156
Mailing Address - Street 2:
Mailing Address - City:LIBERTYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21762
Mailing Address - Country:US
Mailing Address - Phone:301-898-0046
Mailing Address - Fax:301-898-0049
Practice Address - Street 1:11055 LITTLE PATUXENT PKY
Practice Address - Street 2:SUITE L-6
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-730-9775
Practice Address - Fax:410-730-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
MDA1463261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414614000Medicaid
MD414614000Medicaid