SURGICAL ASSOCIATES, CHARTERED

Provider Demographics

• NPI: 1548406960
• Name: SURGICAL ASSOCIATES, CHARTERED
• Entity Type: Organization
• Organization Name: SURGICAL ASSOCIATES, CHARTERED
• Authorized Official - Title/Position: CREDENTIALING/CONTRACTS MANAGER
• Authorized Official - First Name: MICHELLE
• Authorized Official - Last Name: BURTON
• Authorized Official - Phone: 301-868-8485
• Mailing Address - Street 1: 7501 SURRATTS RD
• Mailing Address - Street 2: SUITE 303
• Mailing Address - City: CLINTON
• Mailing Address - State: MD
• Mailing Address - Zip Code: 20735-3362
• Mailing Address - Country: US
• Mailing Address - Phone: 301-868-8485
• Mailing Address - Fax: 301-868-0638
• Practice Address - Street 1: 12070 OLD LINE CTR
• Practice Address - Street 2: SUITE 306
• Practice Address - City: WALDORF
• Practice Address - State: MD
• Practice Address - Zip Code: 20602-2513
• Practice Address - Country: US
• Practice Address - Phone: 301-868-8485
• Practice Address - Fax: 301-868-0638
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2009-01-07
• Last Update Date: 2009-01-07

Provider Licenses

State	License ID	Taxonomies
MD	H0061922	208600000X
MD	D24644	2086S0129X
MD	D0059944	208G00000X
MD	D26021	208G00000X
MD	C0003134	363A00000X
MD	R119098	363LA2100X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2086S0129X	Allopathic & Osteopathic Physicians	Surgery	Vascular Surgery	Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	208G00000X	Allopathic & Osteopathic Physicians	Thoracic Surgery (Cardiothoracic Vascular Surgery)		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	E93554	Other	UPIN
	B94310	Other	UPIN
	C76566	Other	UPIN
	B66909	Other	UPIN
	B94699	Other	UPIN
	C62118	Other	UPIN
	H43765	Other	UPIN
	C62030	Other	UPIN
	S98671	Other	UPIN
	H04537	Other	UPIN
	C62030	Other	UPIN
	E93554	Other	UPIN