Provider Demographics
NPI:1710932207
Name:CENTER FOR UNIVERSAL SURGERY, PC
Entity Type:Organization
Organization Name:CENTER FOR UNIVERSAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:L.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-668-0888
Mailing Address - Street 1:6550 MERCANTILE DR E
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7655
Mailing Address - Country:US
Mailing Address - Phone:301-668-1212
Mailing Address - Fax:
Practice Address - Street 1:604 SOLAREX CT.
Practice Address - Street 2:SUITE 205
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8655
Practice Address - Country:US
Practice Address - Phone:301-668-0888
Practice Address - Fax:301-668-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053489261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTIN
MDG31968Medicare UPIN