NPIMap

Organization Active NPI

Surgical Associates, Chartered

  • Vascular Surgery Physician
  • Waldorf, MD
National Provider Identifier
1548406960
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
D24644 Issued in MD
Legal business name
SURGICAL ASSOCIATES, CHARTERED
Practice address
12070 Old Line Ctr
Suite 306
Waldorf, MD 20602-2513
Phone
(301) 868-8485
Fax
(301) 868-0638
NPI assigned
Jan 7, 2009
Last updated
Apr 28, 2025By the provider in NPPES
Organization subpart
No

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
Michelle Burton
Title
Credentialing/Contracts Manager
Phone
(301) 868-8485

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0003134 MD
Acute Care Nurse Practitioner 363LA2100X R119098 MD
Surgery Physician 208600000X H0061922 MD
Vascular Surgery Physician 2086S0129X D24644 MD Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X D0059944 MD
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X D26021 MD

Addresses

Primary practice location

12070 Old Line Ctr
Suite 306
Waldorf, MD 20602-2513

Mailing address

7501 Surratts Rd
Suite 303
Clinton, MD 20735-3362
Phone (301) 868-8485

Other identifiers 10

IdentifierTypeStateIssuer
H43765OtherUPIN
C76566OtherUPIN
C62030OtherUPIN
S98671OtherUPIN
B94310OtherUPIN
C62118OtherUPIN
E93554OtherUPIN
B66909OtherUPIN
B94699OtherUPIN
H04537OtherUPIN

National Provider Directory

National Provider Directory
Tax ID family
Surgical Associates CTD9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

12070 Old Line Ctr
Ste 306
Waldorf, MD 20602
Phone (301) 843-9769

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1548406960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 SURRATTS RD",
            "address_2": "SUITE 303",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353362",
            "telephone_number": "301-868-8485",
            "fax_number": "301-868-0638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12070 OLD LINE CTR",
            "address_2": "SUITE 306",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022513",
            "telephone_number": "301-868-8485",
            "fax_number": "301-868-0638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES, CHARTERED",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-07",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "BURTON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING/CONTRACTS MANAGER",
        "authorized_official_telephone_number": "301-868-8485"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0003134",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MD",
            "license": "R119098",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "H0061922",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MD",
            "license": "D24644",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MD",
            "license": "D0059944",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MD",
            "license": "D26021",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "H43765",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "C76566",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "C62030",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "S98671",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "B94310",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "C62118",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "E93554",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "B66909",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "B94699",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "H04537",
            "state": null
        }
    ],
    "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.