Basic Information
| Provider Information | |||||||||
| NPI: | 1396089868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON INSTITUTE OF SURGERY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70635 | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208130635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027759375 | ||||||||
| FaxNumber: | 2027769088 | ||||||||
| Practice Location | |||||||||
| Address1: | 2311 M ST NW | ||||||||
| Address2: | SUITE # 501 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200371445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027759375 | ||||||||
| FaxNumber: | 2027769088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2012 | ||||||||
| LastUpdateDate: | 02/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | KALAN | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
| AuthorizedOfficialMiddleName: | M.H. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2027759375 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D54052 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | AL990001 | 01 | CAREFIRST | OTHER |