Provider Demographics
NPI:1447319603
Name:NORTHERN BALTIMORE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:NORTHERN BALTIMORE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-825-3131
Mailing Address - Street 1:110 WEST RD
Mailing Address - Street 2:STE 229
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-825-3131
Mailing Address - Fax:410-825-4037
Practice Address - Street 1:110 WEST RD
Practice Address - Street 2:STE 229
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2316
Practice Address - Country:US
Practice Address - Phone:410-825-3131
Practice Address - Fax:410-825-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1187261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty