Maryland Diagnostic and Therapeutic Endo Center, LLC

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

Legal business name

MARYLAND DIAGNOSTIC AND THERAPEUTIC ENDO CENTER, LLC

Practice address

621 Ridgely Ave
Suite 105
Annapolis, MD 21401-1081

Phone

(410) 224-3636

Fax

(410) 224-6971

NPI assigned

Mar 20, 2009

Last updated

Feb 19, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael S. Epstein, M.D.NPI 1942238928

Title

President

Phone

(410) 266-1588

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Listed as

Maryland Diagnostic and Therapeutic Endo Center LLCCCN 21C0001500

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Samuel Epstein, M.D.

  • Gastroenterology Physician
  • Annapolis, MD
  • NPI 1942238928
  NPD Authorized official
• Barry J Cukor, MD

  • Gastroenterology Physician
  • Annapolis, MD
  • NPI 1316115595
  NPD
• Vishnupriya G Krishna, MD

  • Gastroenterology Physician
  • Annapolis, MD
  • NPI 1902822299
  NPD (past)
• Kevin Randall Wolov, D.O.

  • Gastroenterology Physician
  • Annapolis, MD
  • NPI 1770799447
  NPD (past)

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

{
    "created_epoch": "1237507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1083855092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 RIDGELY AVE",
            "address_2": "SUITE 105",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214011081",
            "telephone_number": "410-224-3636",
            "fax_number": "410-224-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 RIDGELY AVE",
            "address_2": "SUITE 105",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214011081",
            "telephone_number": "410-224-3636",
            "fax_number": "410-224-6971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND DIAGNOSTIC AND THERAPEUTIC ENDO CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-20",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "EPSTEIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-266-1588",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endoscopy Clinic/Center in Annapolis, MD
• Providers in Annapolis, MD by specialty
• Endoscopy Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.