Provider Demographics
NPI:1780036996
Name:MARYLAND SURGICAL LLC
Entity Type:Organization
Organization Name:MARYLAND SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-398-0590
Mailing Address - Street 1:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-7165
Mailing Address - Country:US
Mailing Address - Phone:410-398-0590
Mailing Address - Fax:
Practice Address - Street 1:300 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6737
Practice Address - Country:US
Practice Address - Phone:410-398-0590
Practice Address - Fax:302-595-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty