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Organization
ST. MARY'S MULTISPECIALTY SURGERY CENTER
Active
Organization
ST. MARY'S MULTISPECIALTY SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS H HALLGREN D.P.M. (PRESIDENT)
(301) 862-3338
Entity
Organization
Contact information
Practice address
22325 GREENVIEW PKWY, GREAT MILLS, MD 20634-3491
(301) 862-3338
(301) 862-3335
Mailing address
PO BOX 1310, CALIFORNIA, MD 20619-1310
(301) 862-3338
(301) 862-3335
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1147
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58380901
BLUE CROSS/BLUE SHIELD
MD
01
—
NK9
BLUE CROSS BLUE SHIELD
MD
Enumeration date
08/05/2006
Last updated
08/22/2020
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