Provider Demographics
NPI:1336310986
Name:LAPLATA AMBULATORY UROLOGICAL CENTER, L.L.C.
Entity Type:Organization
Organization Name:LAPLATA AMBULATORY UROLOGICAL CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKITELSHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-392-0525
Mailing Address - Street 1:101 CENTENNIAL ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5975
Mailing Address - Country:US
Mailing Address - Phone:301-392-0525
Mailing Address - Fax:301-392-0458
Practice Address - Street 1:101 CENTENNIAL ST
Practice Address - Street 2:SUITE E
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5975
Practice Address - Country:US
Practice Address - Phone:301-392-0525
Practice Address - Fax:301-392-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
144109Medicare PIN