Provider Demographics
NPI:1861447401
Name:SURGICAL ASSOCIATES, CHARTERED
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-868-8485
Mailing Address - Street 1:7501 SURRATTS RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3362
Mailing Address - Country:US
Mailing Address - Phone:301-868-8485
Mailing Address - Fax:301-868-0638
Practice Address - Street 1:11340 PEMBROOKE SQ
Practice Address - Street 2:SUITE 213
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4808
Practice Address - Country:US
Practice Address - Phone:301-645-8320
Practice Address - Fax:301-645-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID
KN56Medicare PIN