Provider Demographics
NPI:1447439088
Name:ANNAPOLIS COLON AND RECTAL SURGEONS LLC
Entity type:Organization
Organization Name:ANNAPOLIS COLON AND RECTAL SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PROSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-573-1699
Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-573-1699
Mailing Address - Fax:410-573-5311
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-573-1699
Practice Address - Fax:410-573-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56357208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD103601700Medicaid
DC75440001OtherBSDC
MDKCT5OtherBSMD
MDKCT5OtherBSMD
MD387MMedicare PIN
MDG09030Medicare UPIN