Provider Demographics
NPI:1336159284
Name:HOWARD COUNTY GASTROINTESTINAL DIAGNOSTIC CTR, LLC
Entity Type:Organization
Organization Name:HOWARD COUNTY GASTROINTESTINAL DIAGNOSTIC CTR, LLC
Other - Org Name:HOWARD COUNTY GASTROINTESTINAL DIAGNOSTIC CENTER, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-779-6135
Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2858
Mailing Address - Country:US
Mailing Address - Phone:410-772-7345
Mailing Address - Fax:410-772-8860
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2858
Practice Address - Country:US
Practice Address - Phone:410-772-7345
Practice Address - Fax:410-772-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1342261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8362033 00Medicaid
MD8362033 00Medicaid