Basic Information
| Provider Information | |||||||||
| NPI: | 1174130454 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL RADIOSURGERY CENTERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3730 COMMERCE DR STE 12141217 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212271654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044804658 | ||||||||
| FaxNumber: | 6073247615 | ||||||||
| Practice Location | |||||||||
| Address1: | 3730 COMMERCE DR STE 12141217 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212271654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044804658 | ||||||||
| FaxNumber: | 6073247615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2020 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOWERS | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATIONS OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4044804658 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.