Provider Demographics
NPI:1427187285
Name:EYE SURGICALCENTER ASSOCIATES OF BALTIMORE
Entity Type:Organization
Organization Name:EYE SURGICALCENTER ASSOCIATES OF BALTIMORE
Other - Org Name:SURGICENTER AT TOWSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:410-321-4400
Mailing Address - Street 1:1122 KENILWORTH DR
Mailing Address - Street 2:SUITE 18
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2139
Mailing Address - Country:US
Mailing Address - Phone:410-321-4400
Mailing Address - Fax:410-321-4909
Practice Address - Street 1:1122 KENILWORTH DR
Practice Address - Street 2:SUITE 18
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2139
Practice Address - Country:US
Practice Address - Phone:410-321-4400
Practice Address - Fax:410-321-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1150261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical