Provider Demographics
NPI:1922148733
Name:SOUTH RIVER AMBULATORY SURGERY
Entity Type:Organization
Organization Name:SOUTH RIVER AMBULATORY SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SAINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-956-7777
Mailing Address - Street 1:3168 BRAVERTON ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2674
Mailing Address - Country:US
Mailing Address - Phone:410-956-7777
Mailing Address - Fax:410-956-7186
Practice Address - Street 1:3168 BRAVERTON ST
Practice Address - Street 2:SUITE 310
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2674
Practice Address - Country:US
Practice Address - Phone:410-956-7777
Practice Address - Fax:410-956-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1256479261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1654ZMedicare PIN