Provider Demographics
NPI:1891025631
Name:MARYLAND SURGICAL ASSISTANTS
Entity Type:Organization
Organization Name:MARYLAND SURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SPIRO
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANTONIADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-643-2078
Mailing Address - Street 1:104 SAINT DUNSTANS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3310
Mailing Address - Country:US
Mailing Address - Phone:443-643-2078
Mailing Address - Fax:443-643-2088
Practice Address - Street 1:615 W MACPHAIL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4309
Practice Address - Country:US
Practice Address - Phone:443-643-2078
Practice Address - Fax:443-643-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002581363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty