Provider Demographics
NPI:1770551517
Name:SOUTHERN MARYLAND ENDOSCOPY CENTER
Entity type:Organization
Organization Name:SOUTHERN MARYLAND ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-908-5209
Mailing Address - Street 1:5550 FRIENDSHIP BLVD STE T90
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7313
Mailing Address - Country:US
Mailing Address - Phone:301-654-4148
Mailing Address - Fax:202-296-0301
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:SUITE A102
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:301-877-4140
Practice Address - Fax:301-877-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
MDA1345261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical