Basic Information
| Provider Information | |||||||||
| NPI: | 1649272881 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND AMBULATORY SRGCL CTR LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OACM ASC, LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 BENSON AVE | ||||||||
| Address2: | STE G200 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212271016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106441880 | ||||||||
| FaxNumber: | 4435680111 | ||||||||
| Practice Location | |||||||||
| Address1: | 3421 BENSON AVE | ||||||||
| Address2: | STE G200 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212271016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106441880 | ||||||||
| FaxNumber: | 4435680111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 07/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | GORDON | ||||||||
| AuthorizedOfficialFirstName: | CORA | ||||||||
| AuthorizedOfficialMiddleName: | LOCKS | ||||||||
| AuthorizedOfficialTitleorPosition: | ASST. TO CEO | ||||||||
| AuthorizedOfficialTelephone: | 4106441880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | A1350 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.