Basic Information
| Provider Information | |||||||||
| NPI: | 1487239059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AAU GREENBELT ASC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 RIDGELY AVE STE 130 | ||||||||
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| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214011045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102668049 | ||||||||
| FaxNumber: | 4102663831 | ||||||||
| Practice Location | |||||||||
| Address1: | 7855 WALKER DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102668049 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2021 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | HOLTON | ||||||||
| AuthorizedOfficialFirstName: | MARA | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4102468049 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.