Provider Demographics
NPI:1548263619
Name:AZAR EYE SURGERY CENTER LLC
Entity type:Organization
Organization Name:AZAR EYE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-260-2828
Mailing Address - Street 1:31519 WINTERPLACE PKWY
Mailing Address - Street 2:STE 3
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1884
Mailing Address - Country:US
Mailing Address - Phone:443-260-2828
Mailing Address - Fax:443-260-2454
Practice Address - Street 1:31519 WINTERPLACE PKWY
Practice Address - Street 2:STE 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1884
Practice Address - Country:US
Practice Address - Phone:410-546-2500
Practice Address - Fax:443-260-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1355261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD465550800Medicaid
MD490005433Medicare PIN
MD465550800Medicaid