NPIMap

Organization Active NPI

Surgical Associates Chartered

  • Vascular Surgery Physician
  • Waldorf, MD
National Provider Identifier
1508355470
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
SURGICAL ASSOCIATES CHARTERED
Practice address
11370 Pembrooke SQ
Waldorf, MD 20603-4842
Phone
(240) 427-1620
Fax
(301) 645-8663
NPI assigned
May 7, 2018
Organization subpart
Yes
Parent organization
SURGICAL ASSOCIATES CHARTEREDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Mrs. Rita Grover, M.D.
Title
Authorized Official
Phone
(240) 427-1630

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X
Vascular Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2086S0129X Primary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208G00000X

Addresses

Primary practice location

11370 Pembrooke SQ
Waldorf, MD 20603-4842

Mailing address

5801 Allentown Rd Ste 502
Camp Springs, MD 20746-4653
Phone (240) 427-1630

Other identifiers 1

IdentifierTypeStateIssuer
205221100MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
C Banerjee MD9 organizations share this tax ID, including this one
Part of
C Banerjee MD

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1525651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1508355470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5801 ALLENTOWN RD STE 502",
            "city": "CAMP SPRINGS",
            "state": "MD",
            "postal_code": "207464653",
            "telephone_number": "240-427-1630",
            "fax_number": "240-492-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11370 PEMBROOKE SQ",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034842",
            "telephone_number": "240-427-1620",
            "fax_number": "301-645-8663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES CHARTERED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SURGICAL ASSOCIATES CHARTERED",
        "enumeration_date": "2018-05-07",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "GROVER",
        "authorized_official_first_name": "RITA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "240-427-1630",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205221100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.