The Adult & Pediatric Urology Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

A1408 Issued in MD

Legal business name

THE ADULT & PEDIATRIC UROLOGY SURGERY CENTER LLC

Practice address

3455 Wilkens Ave
Suite 100
Baltimore, MD 21229-5213

Phone

(410) 646-0330

Fax

(410) 644-6182

NPI assigned

Jan 18, 2007

Organization subpart

No

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

Authorized official

Name

Bridget Mastrounni

Title

Administrator

Phone

(410) 646-0331

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357516800000",
    "number": "1396897351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 WILKENS AVE",
            "address_2": "SUITE 100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295213",
            "telephone_number": "410-646-0330",
            "fax_number": "410-644-6182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 WILKENS AVE",
            "address_2": "SUITE 100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212295213",
            "telephone_number": "410-646-0330",
            "fax_number": "410-644-6182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ADULT & PEDIATRIC UROLOGY SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2013-01-07",
        "status": "A",
        "authorized_official_last_name": "MASTROUNNI",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "410-646-0331"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI PROVIDER NUMBER",
            "identifier": "2139146",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "RT9",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FEDERAL PROV. NO.",
            "identifier": "RT9",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408678300",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST OF MD",
            "identifier": "64491801",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dhiviya Tharmaratnam, M.D.
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• Braeden Thayer
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• The Ans Group, LLC
• The Arc of Balimore

• Ambulatory Surgical Clinic/Center in Baltimore, MD
• Providers in Baltimore, 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 Jan 7, 2013; 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.