Provider Demographics
NPI:1255347019
Name:MARYLAND SURGEONS PA
Entity type:Organization
Organization Name:MARYLAND SURGEONS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-546-1630
Mailing Address - Street 1:716 MAIDEN CHOICE LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5943
Mailing Address - Country:US
Mailing Address - Phone:443-546-1630
Mailing Address - Fax:443-546-1626
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:443-546-1630
Practice Address - Fax:443-546-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S208Medicare PIN