Provider Demographics
NPI:1578129599
Name:METRO MOHS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:METRO MOHS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BRADIE
Authorized Official - Last Name:TONER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-515-6674
Mailing Address - Street 1:6616 81ST ST
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1205
Mailing Address - Country:US
Mailing Address - Phone:240-515-6674
Mailing Address - Fax:
Practice Address - Street 1:5501 BACKLICK RD STE 120
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3940
Practice Address - Country:US
Practice Address - Phone:301-966-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty