1649272881 NPI number — ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND AMBULATORY SRGCL CTR LLC

Table of content: (NPI 1649272881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649272881 NPI number — ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND AMBULATORY SRGCL CTR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND AMBULATORY SRGCL CTR LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OACM ASC, LLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649272881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3421 BENSON AVE
Provider Second Line Business Mailing Address:
STE G200
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21227-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-644-1880
Provider Business Mailing Address Fax Number:
443-568-0111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3421 BENSON AVE
Provider Second Line Business Practice Location Address:
STE G200
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-644-1880
Provider Business Practice Location Address Fax Number:
443-568-0111
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
CORA
Authorized Official Middle Name:
LOCKS
Authorized Official Title or Position:
ASST. TO CEO
Authorized Official Telephone Number:
410-644-1880

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1350 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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