Maryland Aesthetic and Reconstructive Ambulatory Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

A1296 Issued in MD

Legal business name

MARYLAND AESTHETIC AND RECONSTRUCTIVE AMBULATORY SURGICAL CENTER LLC

Practice address

8415 Bellona LN
Suite 212
Towson, MD 21204-2055

Phone

(410) 825-4022

Fax

(410) 825-6439

NPI assigned

Nov 27, 2006

Last updated

Mar 9, 2012By 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. Darab Hormozi, M.D.NPI 1346316098

Title

President

Phone

(410) 825-4022

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Listed as

Maryland Aesthetic and Reconstructive ASC LLCCCN 21C0001296

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 2

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.

• Darab Hormozi, M.D.

  • Ophthalmology Physician
  • Towson, MD
  • NPI 1346316098
  NPD Authorized official
• Susan Eapen Hormozi, L.AC

  • Acupuncturist
  • Towson, MD
  • NPI 1780916767
  NPD (past)

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331251200000",
    "number": "1528134293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8415 BELLONA LN",
            "address_2": "SUITE 212",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212042055",
            "telephone_number": "410-825-4022",
            "fax_number": "410-825-6439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8415 BELLONA LN",
            "address_2": "SUITE 212",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212042055",
            "telephone_number": "410-825-4022",
            "fax_number": "410-825-6439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND AESTHETIC AND RECONSTRUCTIVE AMBULATORY SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2012-03-09",
        "status": "A",
        "authorized_official_last_name": "HORMOZI",
        "authorized_official_first_name": "DARAB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-825-4022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MD",
            "license": "A1296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Mineo Martinez, MD
• Christa Marvenko-Athas, LCSW-C
• Evelyn Linda Marx, L.C.S.W.-C., PH.D.
• Mary Jo Fishburn, M.D., PA
• Mary Teddy Wray DDS Dba Towson Extreme Smiles
• Maryland CVS Pharmacy LLC (CVS Pharmacy 04129)
• Maryland CVS Pharmacy LLC (CVS Pharmacy #16506)
• Maryland CVS Pharmacy, L.L.C. (CVS Pharmacy # 02216)
• Maryland Endoscopy Anesthesia LLC
• Maryland Endoscopy Center LLC (Maryland Endoscopy Center)

• Ambulatory Surgical Clinic/Center in Towson, MD
• Providers in Towson, 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 Mar 9, 2012; 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.