Organization
PENINSULA ENDOSCOPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOTA L CHANDRASEKHARA M.D. (PRESIDENT)
(410) 896-9005
Entity
Organization
Contact information
Practice address
9315 OCEAN HIGHWAY, DELMAR, MD 21875-2339
(410) 896-9005
(410) 896-9337
Mailing address
9315 OCEAN HIGHWAY, DELMAR, MD 21875-2339
(410) 896-9005
(410) 896-9337
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
014352
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409018700
—
MD
Enumeration date
01/23/2007
Last updated
09/10/2008
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