Provider Demographics
NPI:1558762906
Name:SURGICAL ASSOCIATES OF MARYLAND
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-398-0590
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21922-0428
Mailing Address - Country:US
Mailing Address - Phone:410-398-0590
Mailing Address - Fax:443-485-6531
Practice Address - Street 1:300 E PULASKI HWY
Practice Address - Street 2:SUITE 122
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6737
Practice Address - Country:US
Practice Address - Phone:410-398-0590
Practice Address - Fax:443-485-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty