Provider Demographics
NPI:1568622181
Name:WASHINGTON SURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:WASHINGTON SURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HITESH
Authorized Official - Middle Name:PRAVIN
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-292-7200
Mailing Address - Street 1:11701 LIVINGSTON RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5146
Mailing Address - Country:US
Mailing Address - Phone:301-292-7200
Mailing Address - Fax:301-292-9639
Practice Address - Street 1:11701 LIVINGSTON RD
Practice Address - Street 2:SUITE 308
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5146
Practice Address - Country:US
Practice Address - Phone:301-292-7200
Practice Address - Fax:301-292-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064673208600000X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD9JPWAOtherCAREFIRST MD
DCQ906OtherCAREFIRST DC