Provider Demographics
NPI:1376611665
Name:INTEGRATED SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:INTEGRATED SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-360-1855
Mailing Address - Street 1:13437 CRANDALL CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1029
Mailing Address - Country:US
Mailing Address - Phone:804-360-1855
Mailing Address - Fax:804-360-1629
Practice Address - Street 1:8241 GEORGIA AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4510
Practice Address - Country:US
Practice Address - Phone:301-589-8737
Practice Address - Fax:240-450-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-03
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061148174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001014600OtherMARYLAND MEDICAL ASSISTANCE (MAO)
MD105656OtherATHTHEM BC BS
VA238514OtherBC BS
MD3640878OtherAETNA
MD826AOtherCAREFIRST CAPITAL CARE
MD21849OtherCIGNA
MD5396573OtherAETNA PPO
DC105657OtherANTHEM BC BS
MD458642OtherMAMSI
MD001014600Medicaid
DC036747600Medicaid
MD238513OtherANTHEM BC BS
MD718333OtherNCPPO UNICARE
MD1014600Medicaid
5798960OtherCIGNA
MDJ740-001OtherCAREFIRST BC BS
MD826AOtherCAREFIRST CAPITAL CARE
MDG01981Medicare PIN
VAC10445Medicare PIN