Provider Demographics
NPI:1730142415
Name:CENTRAL MARYLAND SURGICAL CENTER
Entity Type:Organization
Organization Name:CENTRAL MARYLAND SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MANAGED CARE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:636-549-2384
Mailing Address - Street 1:197 THOMAS JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4314
Mailing Address - Country:US
Mailing Address - Phone:301-624-5510
Mailing Address - Fax:301-624-5370
Practice Address - Street 1:197 THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4314
Practice Address - Country:US
Practice Address - Phone:301-624-5510
Practice Address - Fax:301-624-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1383261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical