Provider Demographics
NPI:1508355470
Name:SURGICAL ASSOCIATES CHARTERED
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-427-1630
Mailing Address - Street 1:5801 ALLENTOWN RD STE 502
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4653
Mailing Address - Country:US
Mailing Address - Phone:240-427-1630
Mailing Address - Fax:240-492-2070
Practice Address - Street 1:11370 PEMBROOKE SQ
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4842
Practice Address - Country:US
Practice Address - Phone:240-427-1620
Practice Address - Fax:301-645-8663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGICAL ASSOCIATES CHARTERED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD205221100Medicaid