Provider Demographics
NPI:1518206838
Name:ADVANCED SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAHM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-475-4900
Mailing Address - Street 1:1401 FOULK RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2763
Mailing Address - Country:US
Mailing Address - Phone:302-475-4900
Mailing Address - Fax:302-475-4907
Practice Address - Street 1:1401 FOULK RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2763
Practice Address - Country:US
Practice Address - Phone:302-475-4900
Practice Address - Fax:302-475-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007575208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE003990C55Medicare PIN