Basic Information
Provider Information
NPI: 1568622181
EntityType: 2
ReplacementNPI:  
OrganizationName: WASHINGTON SURGICAL SPECIALISTS, LLC
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Mailing Information
Address1: 11701 LIVINGSTON RD
Address2: SUITE 308
City: FORT WASHINGTON
State: MD
PostalCode: 207445146
CountryCode: US
TelephoneNumber: 3012927200
FaxNumber: 3012929639
Practice Location
Address1: 11701 LIVINGSTON RD
Address2: SUITE 308
City: FORT WASHINGTON
State: MD
PostalCode: 207445146
CountryCode: US
TelephoneNumber: 3012927200
FaxNumber: 3012929639
Other Information
ProviderEnumerationDate: 06/17/2008
LastUpdateDate: 02/08/2012
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: AMIN
AuthorizedOfficialFirstName: HITESH
AuthorizedOfficialMiddleName: PRAVIN
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 3012927200
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XD0064673MDN193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 
208600000X  Y193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
D9JPWA01MDCAREFIRST MDOTHER
Q90601DCCAREFIRST DCOTHER


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