Organization
STANFORD SURGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON CHARLES STANFORD (OWNER PHYSICIAN ASSISTANT)
(301) 528-0868
Entity
Organization
Contact information
Practice address
19466 CARAVAN DR, GERMANTOWN, MD 20874-6220
(301) 528-0868
Mailing address
19466 CARAVAN DR, GERMANTOWN, MD 20874-6220
(301) 528-0868
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C0002208
MD
Other
Enumeration date
01/25/2008
Last updated
01/25/2008
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