Provider Demographics
NPI:1407947112
Name:AMBULATORY SURGERY CENTER OF BETHESDA, LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGERY CENTER OF BETHESDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-984-8600
Mailing Address - Street 1:11210 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3202
Mailing Address - Country:US
Mailing Address - Phone:301-984-8600
Mailing Address - Fax:301-984-8601
Practice Address - Street 1:11210 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3202
Practice Address - Country:US
Practice Address - Phone:301-984-8600
Practice Address - Fax:301-984-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1371261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1612Medicare ID - Type Unspecified