Provider Demographics
NPI:1790083418
Name:LEVEL ONE SURGICAL
Entity Type:Organization
Organization Name:LEVEL ONE SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HERTIG
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:410-419-9194
Mailing Address - Street 1:2905 FALLSTAFF RD
Mailing Address - Street 2:APT. 21
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3275
Mailing Address - Country:US
Mailing Address - Phone:410-419-9194
Mailing Address - Fax:
Practice Address - Street 1:2905 FALLSTAFF RD
Practice Address - Street 2:APT. 21
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3275
Practice Address - Country:US
Practice Address - Phone:410-419-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty