Provider Demographics
NPI:1871941468
Name:AMBULATORY SURGERY CENTER FOR PELVIC NEURO SCIENCE LLC
Entity type:Organization
Organization Name:AMBULATORY SURGERY CENTER FOR PELVIC NEURO SCIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-343-3001
Mailing Address - Street 1:1447 YORK RD STE 406
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6057
Mailing Address - Country:US
Mailing Address - Phone:410-343-3001
Mailing Address - Fax:410-823-0015
Practice Address - Street 1:1447 YORK RD
Practice Address - Street 2:SUITE 406
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6017
Practice Address - Country:US
Practice Address - Phone:410-343-3001
Practice Address - Fax:410-834-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical