Organization
SURGICAL ASSOCIATES, CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BURTON (CREDENTIALING/CONTRACTS MANAGER)
(301) 868-8485
Entity
Organization
Contact information
Practice address
12070 OLD LINE CTR, SUITE 306, WALDORF, MD 20602-2513
(301) 868-8485
(301) 868-0638
Mailing address
7501 SURRATTS RD, SUITE 303, CLINTON, MD 20735-3362
(301) 868-8485
(301) 868-0638
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
H0061922
MD
2086S0129X
Vascular Surgery Physician
Primary
D24644
MD
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
D0059944
MD
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
D26021
MD
363A00000X
Physician Assistant
C0003134
MD
363LA2100X
Acute Care Nurse Practitioner
R119098
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B66909
UPIN
—
01
—
B94310
UPIN
—
01
—
B94699
UPIN
—
01
—
C62030
UPIN
—
01
—
C62118
UPIN
—
01
—
C76566
UPIN
—
01
—
E93554
UPIN
—
01
—
H04537
UPIN
—
01
—
H43765
UPIN
—
01
—
S98671
UPIN
—
Enumeration date
01/07/2009
Last updated
04/28/2025
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