Provider Demographics
NPI:1144608514
Name:MDP SURGERY CENTER
Entity Type:Organization
Organization Name:MDP SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-490-4000
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-0404
Mailing Address - Country:US
Mailing Address - Phone:443-490-4000
Mailing Address - Fax:443-484-2831
Practice Address - Street 1:216 E PULASKI HWY
Practice Address - Street 2:120
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6497
Practice Address - Country:US
Practice Address - Phone:443-490-4000
Practice Address - Fax:443-484-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057974261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF88893Medicare UPIN