Provider Demographics
NPI:1508931551
Name:SURGICAL ASSOCIATES, CHARTERED
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-427-1720
Mailing Address - Street 1:3510 OLD WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3233
Mailing Address - Country:US
Mailing Address - Phone:240-427-1720
Mailing Address - Fax:240-427-1785
Practice Address - Street 1:3510 OLD WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3233
Practice Address - Country:US
Practice Address - Phone:240-427-1720
Practice Address - Fax:240-427-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00246442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KN56Medicare PIN