Basic Information
| Provider Information | |||||||||
| NPI: | 1518634732 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDSTAR HEALTH ENDOSCOPY CENTER - SILVER SPRING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12002 VEIRS MILL RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209064513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013700810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12002 VEIRS MILL RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209064513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013700810 | ||||||||
| FaxNumber: | 3017740505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2021 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4107726696 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X | N | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | A1652 | 01 | MD | MARYLAND DEPARTMENT OF HEALTH OFFICE OF HEALTH CARE QULITY | OTHER | 881663800 | 05 | MD | MEDICAID |