Provider Demographics
NPI:1467844068
Name:WEST ANNAPOLIS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:WEST ANNAPOLIS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDEL
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:410-266-7102
Mailing Address - Street 1:104 RIDGELY AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1439
Mailing Address - Country:US
Mailing Address - Phone:410-266-7102
Mailing Address - Fax:410-266-6042
Practice Address - Street 1:104 RIDGELY AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1439
Practice Address - Country:US
Practice Address - Phone:410-266-7102
Practice Address - Fax:410-266-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1306018866Medicare UPIN