Provider Demographics
NPI:1225361751
Name:SUBURBAN HOSPITAL, INC.
Entity Type:Organization
Organization Name:SUBURBAN HOSPITAL, INC.
Other - Org Name:SUBURBAN HOSPITAL RADIATION ONCOLOGY INFUSION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAGNOLATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-896-2574
Mailing Address - Street 1:SUBURBAN HOSPITAL INC
Mailing Address - Street 2:PO BOX 79216
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0216
Mailing Address - Country:US
Mailing Address - Phone:301-896-6002
Mailing Address - Fax:
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:SUITE 4100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-896-3856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUBURBAN HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-16
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD800022Medicare PIN