Provider Demographics
NPI:1275710436
Name:HANOVER PARKWAY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HANOVER PARKWAY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HADDIS
Authorized Official - Middle Name:TESFAYOHANNES
Authorized Official - Last Name:HAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-2333
Mailing Address - Street 1:7300 HANOVER DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-220-2333
Mailing Address - Fax:301-220-2339
Practice Address - Street 1:7300 HANOVER DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-220-2333
Practice Address - Fax:301-220-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical