1265522478 NPI number — LANDOVER AMBULATORY SURGERY, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265522478 NPI number — LANDOVER AMBULATORY SURGERY, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANDOVER AMBULATORY SURGERY, LP
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:
Provider Other Organization Name Type Code:
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:
1265522478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 MERCANTILE LN
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-5327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-773-3338
Provider Business Mailing Address Fax Number:
301-773-3305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MERCANTILE LN
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20774-5327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-773-3338
Provider Business Practice Location Address Fax Number:
301-773-3305
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OBIOHA
Authorized Official First Name:
ADAEZE
Authorized Official Middle Name:
I.
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
301-773-3338

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1294 , 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)

  • Identifier: A1294 . This is a "LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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