Provider Demographics
NPI:1750322467
Name:TWIN ARCH SURGICAL CENTER
Entity Type:Organization
Organization Name:TWIN ARCH SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-695-9669
Mailing Address - Street 1:1001 TWIN ARCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-4138
Mailing Address - Country:US
Mailing Address - Phone:301-829-5111
Mailing Address - Fax:301-695-0346
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 3
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:301-695-9669
Practice Address - Fax:301-695-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1285213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD086ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #