NPIMap

Organization Active NPI

White Square Vascular Surgery PA

  • Durable Medical Equipment & Medical Supplies
  • Lutherville, MD
National Provider Identifier
1053068809
Registry record updated Apr 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
WHITE SQUARE VASCULAR SURGERY PA
Practice address
2324 W Joppa Rd Ste 100
Lutherville, MD 21093-4617
Phone
(410) 918-1525
NPI assigned
Mar 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ahmad Abu-GhaidaNPI 1659320257
Title
MD Owner
Phone
(443) 255-4750

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

2324 W Joppa Rd Ste 100
Lutherville, MD 21093-4617

Mailing address

5233 King Ave Ste 208
Baltimore, MD 21237-4003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220701001678 MD DME Supplier - Physician - General Practice 5890791735 Practice locations: Lutherville, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
White Square Vas Surg PA4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2021B Emmorton Rd
Ste 208
Bel Air, MD 21015
Phone (410) 918-1525

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712448000000",
    "number": "1053068809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5233 KING AVE STE 208",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212374003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2324 W JOPPA RD STE 100",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210934617",
            "telephone_number": "410-918-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE SQUARE VASCULAR SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-02",
        "last_updated": "2024-04-07",
        "certification_date": "2024-04-07",
        "status": "A",
        "authorized_official_last_name": "ABU-GHAIDA",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_title_or_position": "MD OWNER",
        "authorized_official_telephone_number": "443-255-4750"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutherville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.