Provider Demographics
NPI:1942230024
Name:LUTHERVILLE ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:LUTHERVILLE ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-821-1900
Mailing Address - Street 1:1300 BELLONA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5466
Mailing Address - Country:US
Mailing Address - Phone:410-821-1900
Mailing Address - Fax:410-821-1904
Practice Address - Street 1:1300 BELLONA AVE STE A
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5466
Practice Address - Country:US
Practice Address - Phone:410-821-1900
Practice Address - Fax:410-821-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1395261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405346000Medicaid
MD168ZMedicare PIN