Provider Demographics
NPI:1962449652
Name:PLAZA AMBULATORY SURGICAL CENTER, INC
Entity Type:Organization
Organization Name:PLAZA AMBULATORY SURGICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-764-7044
Mailing Address - Street 1:6506 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-2304
Mailing Address - Country:US
Mailing Address - Phone:410-764-7044
Mailing Address - Fax:410-764-8637
Practice Address - Street 1:6506 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2304
Practice Address - Country:US
Practice Address - Phone:410-764-7044
Practice Address - Fax:410-764-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1175261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0324490OtherCIGNA
5829135OtherAETNA
127216OtherJHHP