Provider Demographics
NPI:1477098127
Name:SOUTHERN MARYLAND GENERAL SURGERY LLC
Entity Type:Organization
Organization Name:SOUTHERN MARYLAND GENERAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDEL AZIZ
Authorized Official - Middle Name:BASHA
Authorized Official - Last Name:EL SAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-843-9060
Mailing Address - Street 1:3261 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 1012
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3223
Mailing Address - Country:US
Mailing Address - Phone:301-843-9060
Mailing Address - Fax:301-645-3092
Practice Address - Street 1:3261 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 1012
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3223
Practice Address - Country:US
Practice Address - Phone:301-843-9060
Practice Address - Fax:301-645-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034140208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC48845Medicare UPIN