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Organization
ANTIETAM UROSURGICAL CENTER LLC ASC
Active
Organization
ANTIETAM UROSURGICAL CENTER LLC ASC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBBIE K KLAUKA MBA (ADMINISTRATOR)
(301) 665-4879
Entity
Organization
Contact information
Practice address
11110 MEDICAL CAMPUS RD, SUITE 228, HAGERSTOWN, MD 21742-6700
(301) 733-0022
(301) 733-3461
Mailing address
PO BOX 37768, BALTIMORE, MD 21297-3768
(301) 733-0022
(301) 733-3461
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1224
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21C0001224
CCN
—
Enumeration date
05/30/2006
Last updated
03/22/2016
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