Provider Demographics
NPI:1467521377
Name:HARFORD SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:HARFORD SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PA
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:410-937-6331
Mailing Address - Street 1:79 PICCADILLY CT
Mailing Address - Street 2:
Mailing Address - City:COLORA
Mailing Address - State:MD
Mailing Address - Zip Code:21917-1540
Mailing Address - Country:US
Mailing Address - Phone:410-937-6331
Mailing Address - Fax:
Practice Address - Street 1:79 PICCADILLY CT
Practice Address - Street 2:
Practice Address - City:COLORA
Practice Address - State:MD
Practice Address - Zip Code:21917-1540
Practice Address - Country:US
Practice Address - Phone:410-937-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416MMedicare ID - Type UnspecifiedGROUP