Basic Information
| Provider Information | |||||||||
| NPI: | 1679750285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES COUNTY SURGICAL CENTER, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 ALTAMONT PL | ||||||||
| Address2: | THIRD FLOOR UNIT 3 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206953063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013749591 | ||||||||
| FaxNumber: | 3016454734 | ||||||||
| Practice Location | |||||||||
| Address1: | 4225 ALTAMONT PL | ||||||||
| Address2: | THIRD FLOOR UNIT 3 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206953063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013749591 | ||||||||
| FaxNumber: | 3016454734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2008 | ||||||||
| LastUpdateDate: | 01/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | BERGER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3013749591 | ||||||||
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| 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 | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.