Provider Demographics
NPI:1023135977
Name:BURTONSVILLE SURGICAL CENTER
Entity type:Organization
Organization Name:BURTONSVILLE SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:KRESSIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-384-2629
Mailing Address - Street 1:15300 SPENCERVILLE CT STE 101
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1639
Mailing Address - Country:US
Mailing Address - Phone:301-384-2629
Mailing Address - Fax:301-421-4286
Practice Address - Street 1:15300 SPENCERVILLE CT STE 101
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1639
Practice Address - Country:US
Practice Address - Phone:301-384-2629
Practice Address - Fax:301-421-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1148261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA1148OtherSTATE LICENSE
309887Medicare ID - Type Unspecified