Provider Demographics
NPI:1396089868
Name:WASHINGTON INSTITUTE OF SURGERY LLC
Entity type:Organization
Organization Name:WASHINGTON INSTITUTE OF SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:MH
Authorized Official - Last Name:KALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:571-275-9279
Mailing Address - Street 1:PO BOX 60428
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-0428
Mailing Address - Country:US
Mailing Address - Phone:571-275-9279
Mailing Address - Fax:301-519-3797
Practice Address - Street 1:13116 BRUSHWOOD WAY
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1025
Practice Address - Country:US
Practice Address - Phone:571-275-9279
Practice Address - Fax:301-519-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD54052208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL990001OtherCAREFIRST
AL990001OtherCAREFIRST
MD018583W58Medicare PIN