Provider Demographics
NPI:1922251669
Name:SURGICAL ASSOCIATES, CHARTERED
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/CONTRACTS 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:240-427-1630
Mailing Address - Street 1:5801 ALLENTOWN RD STE 502
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4653
Mailing Address - Country:US
Mailing Address - Phone:240-427-1630
Mailing Address - Fax:240-492-2070
Practice Address - Street 1:5801 ALLENTOWN RD
Practice Address - Street 2:SUITE 502
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4563
Practice Address - Country:US
Practice Address - Phone:240-427-1760
Practice Address - Fax:240-427-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0061922208600000X
MDD00246442086S0129X
MDD00286392086S0129X
MDD0026021208G00000X
MDD0059944208G00000X
208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KN56OtherPTAN
429555OtherPTAN
B66909Medicare UPIN
H43765Medicare UPIN
C62030Medicare UPIN
429555OtherPTAN
B94310Medicare UPIN
KN56OtherPTAN
S98671Medicare UPIN
C76566Medicare UPIN