MASSACHUSETTS AVENUE SURGICAL CONSULTANTS LLC - NPI 1104161082

Q: What is the provider's specialty?

The provider's specialty is with taxonomy code 246ZS0400X.

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About Massachusetts Avenue Surgical Consultants Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MASSACHUSETTS AVENUE SURGICAL CONSULTANTS LLC (NPI 1104161082) is a healthcare organization registered with NPPES in Bethesda, Maryland and active in the NPI registry since December 2012. The organization holds a CLIA Waiver certificate valid through September 8, 2026 and lists Randall Gross, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1104161082

Entity TypeOrganization

Primary Taxonomy246ZS0400X

Legal Business NameMASSACHUSETTS AVENUE SURGICAL CONSULTANTS LLC

Location Address6400 GOLDSBORO RD STE 400Bethesda, MD 20817-5846

Mailing Address6400 Goldsboro Rd Ste 400Bethesda, MD 20817-5846 · (301) 263-0800 · Fax (301) 263-0820

Phone(301) 263-0800

Fax(301) 263-0820

Organization SubpartYesParent: Massachusetts Avenue Consulting Services Llc

Authorized OfficialRandall GrossExecutive Director · (301) 263-0800

Enumeration DateDecember 4, 2012

✔ NPI 1104161082 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary Specialty

Taxonomy Code246ZS0400X

6400 GOLDSBORO RD STE 400, Bethesda, MD 20817

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 21D1078564

Massachusetts Avenue Surgery Center · Bethesda, MD

Active · expires Sep 8, 2026

CLIA Number21D1078564

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateSeptember 9, 2024

Certificate Expiration DateSeptember 8, 2026

Laboratory DirectorChristopher Stanton Edwards

Laboratory Phone(301) 263-0800

Laboratory LocationMassachusetts Avenue Surgery Center6400 Goldsboro Road Suite 400, Bethesda, MD 20817

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TWILI HARRIS

Student in an Organized Health Care Education/Training Program