1679149330 NPI number — ADVANCED SURGICAL CARE OF MARYLAND, LLC

Table of content: RICHARD STANDISH STOCKWELL JR. P.T. (NPI 1750437844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679149330 NPI number — ADVANCED SURGICAL CARE OF MARYLAND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SURGICAL CARE OF MARYLAND, 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:
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:
1679149330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4395 NICOLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706-4349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-683-8172
Provider Business Mailing Address Fax Number:
301-683-8173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4395 NICOLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-683-8172
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
RULAND
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-683-8172

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com