Provider Demographics
NPI:1154476372
Name:UROLOGICAL CONSULTANTS PA AMBULATORY SURGERY CENTER ASC
Entity Type:Organization
Organization Name:UROLOGICAL CONSULTANTS PA AMBULATORY SURGERY CENTER ASC
Other - Org Name:AMBULATORY UROSURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RATNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-309-8219
Mailing Address - Street 1:401 E JEFFERSON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2617
Mailing Address - Country:US
Mailing Address - Phone:301-309-8219
Mailing Address - Fax:301-309-9370
Practice Address - Street 1:401 E JEFFERSON ST STE 105
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2617
Practice Address - Country:US
Practice Address - Phone:301-309-8219
Practice Address - Fax:301-309-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1082261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD142941800Medicaid
DC309374Medicare PIN