Provider Demographics
NPI:1649272881
Name:ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND AMBULATORY SRGCL CTR LLC
Entity type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND AMBULATORY SRGCL CTR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. TO CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CORA
Authorized Official - Middle Name:LOCKS
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-644-1880
Mailing Address - Street 1:3421 BENSON AVE
Mailing Address - Street 2:STE G200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1016
Mailing Address - Country:US
Mailing Address - Phone:410-644-1880
Mailing Address - Fax:443-568-0111
Practice Address - Street 1:3421 BENSON AVE
Practice Address - Street 2:STE G200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1016
Practice Address - Country:US
Practice Address - Phone:410-644-1880
Practice Address - Fax:443-568-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1350261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD763ZMedicare ID - Type Unspecified