Provider Demographics
NPI:1619324068
Name:ANNAPOLIS SURGERY PAVILION, LLC.
Entity Type:Organization
Organization Name:ANNAPOLIS SURGERY PAVILION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CNOR
Authorized Official - Phone:410-935-5194
Mailing Address - Street 1:166 DEFENSE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7034
Mailing Address - Country:US
Mailing Address - Phone:410-643-1999
Mailing Address - Fax:
Practice Address - Street 1:166 DEFENSE HWY STE 101
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7034
Practice Address - Country:US
Practice Address - Phone:410-643-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical