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Organization
THE ADULT & PEDIATRIC UROLOGY SURGERY CENTER LLC
Active
Organization
THE ADULT & PEDIATRIC UROLOGY SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGET MASTROUNNI (ADMINISTRATOR)
(410) 646-0331
Entity
Organization
Contact information
Practice address
3455 WILKENS AVE, SUITE 100, BALTIMORE, MD 21229-5213
(410) 646-0330
(410) 644-6182
Mailing address
3455 WILKENS AVE, SUITE 100, BALTIMORE, MD 21229-5213
(410) 646-0330
(410) 644-6182
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1408
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2139146
MAMSI PROVIDER NUMBER
MD
05
—
408678300
—
MD
01
—
64491801
CAREFIRST OF MD
MD
01
—
RT9
BLUE CHOICE
MD
Enumeration date
01/18/2007
Last updated
01/07/2013
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