Provider Demographics
NPI:1871718270
Name:PRINCE GEORGES MULTI SPECIALTY SURGERY CENTER
Entity type:Organization
Organization Name:PRINCE GEORGES MULTI SPECIALTY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUBSER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-499-3338
Mailing Address - Street 1:8700 CENTRAL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4831
Mailing Address - Country:US
Mailing Address - Phone:301-499-3338
Mailing Address - Fax:301-499-1266
Practice Address - Street 1:8700 CENTRAL AVENUE
Practice Address - Street 2:SUITE 105
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4831
Practice Address - Country:US
Practice Address - Phone:301-499-3338
Practice Address - Fax:301-499-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1073261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA1073OtherSTATE LICENSE