Provider Demographics
NPI:1508813197
Name:ENDOSCOPY CENTER AT TOWSON, INC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER AT TOWSON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NOAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-494-1846
Mailing Address - Street 1:7402 YORK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7402 YORK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7532
Practice Address - Country:US
Practice Address - Phone:410-494-1846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1061261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDZZ57OtherMEDICARE PTAN