Provider Demographics
NPI:1437237393
Name:LAUREL AMBULATORY SURGICAL CENTER
Entity type:Organization
Organization Name:LAUREL AMBULATORY SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:QUARTO
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:410-451-3206
Mailing Address - Street 1:2401 BRANDERMILL BLVD
Mailing Address - Street 2:# 340
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1690
Mailing Address - Country:US
Mailing Address - Phone:410-451-3206
Mailing Address - Fax:410-451-3207
Practice Address - Street 1:2401 BRANDERMILL BLVD
Practice Address - Street 2:# 340
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1690
Practice Address - Country:US
Practice Address - Phone:410-451-3206
Practice Address - Fax:410-451-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1144261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211144Medicaid