NPI 1710247440

Civista Clinical Services, LLC

Organisation Surgery Physician La Plata, MD

Practice location

Address: 500 Charles St, La Plata, MD 20646-5931
Phone: (301) 609-4539
Mailing address: 75 Remittance Dr Dept 6554, Chicago, IL 60675-6554

Authorised official

Name: Stephanie Simm
Title: Physician Relations Specialist
Phone: (301) 609-4539

Registered specialties (3)

Surgery Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208600000X

Other Surgery providers in Maryland →

Otolaryngology Physician

Allopathic & Osteopathic Physicians Taxonomy 207Y00000X

Other Otolaryngology providers in Maryland →

Vascular Surgery Physician

Allopathic & Osteopathic Physicians Taxonomy 2086S0129X

Registry record

NPI: 1710247440
Entity type: Organization
NPI issued: 29 May 2012
Record last updated: 12 Jun 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.