Basic Information
| Provider Information | |||||||||
| NPI: | 1366684326 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRINCE FREDERICK SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 SHERRY LN STE 101 | ||||||||
| Address2: | |||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206783276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434864230 | ||||||||
| FaxNumber: | 4434864231 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 SHERRY LANE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178892040 | ||||||||
| FaxNumber: | 4178872125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2009 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | BRESSMAN | ||||||||
| AuthorizedOfficialFirstName: | SARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4027796135 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.