Provider Demographics
NPI:1376839092
Name:BALTIMORE SURGICAL, LLC
Entity Type:Organization
Organization Name:BALTIMORE SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YASSAR
Authorized Official - Middle Name:KHALIL
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-542-1722
Mailing Address - Street 1:PO BOX 5381
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-0381
Mailing Address - Country:US
Mailing Address - Phone:615-525-1626
Mailing Address - Fax:
Practice Address - Street 1:2411 W BELVEDERE AVE
Practice Address - Street 2:STE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5228
Practice Address - Country:US
Practice Address - Phone:410-542-1722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071504208600000X
MDD54931208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty