Lakeforest Ambulatory Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

A1136 Issued in MD

Legal business name

LAKEFOREST AMBULATORY SURGERY CENTER

Practice address

6400 Marlboro Pike
District Heights, MD 20747-2841

Phone

(301) 736-6900

Fax

(301) 736-7180

NPI assigned

Jul 11, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Michael Lawrence Michetti, DPM

Title

Medical Director and Owner

Phone

(301) 948-3668

Specialties & licenses 1

Addresses

Other names 1

• District Heights Ambulatory Surgery Center Other name

Locations

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215734400000",
    "number": "1326202086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 RUSSELL AVE",
            "address_2": "SUITE 103",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772606",
            "telephone_number": "301-948-3668",
            "fax_number": "301-926-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 MARLBORO PIKE",
            "city": "DISTRICT HEIGHTS",
            "state": "MD",
            "postal_code": "207472841",
            "telephone_number": "301-736-6900",
            "fax_number": "301-736-7180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEFOREST AMBULATORY SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-11",
        "last_updated": "2008-07-11",
        "status": "A",
        "authorized_official_last_name": "MICHETTI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR AND OWNER",
        "authorized_official_telephone_number": "301-948-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "District Heights Ambulatory Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Patrick B Larosiliere, D.D.S.
• Joosang Lee
• Mary Lee
• Tandra Nicole Brown Lee, LICSW, LCSW-C

• Ambulatory Surgical Clinic/Center in District Heights, MD
• Providers in District Heights, MD by specialty
• Ambulatory Surgical Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.