MEDICARE: HOLY CROSS ANESTHESIOLOGY ASSOCIATE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1376501007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY CROSS ANESTHESIOLOGY ASSOCIATE PA

Provider Business Mailing Address
First Line	:	PO BOX 64605
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264
Country	:	US
Telephone Number	:	301-933-8554
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 BLACKBURN LN STE 220
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1104
Country	:	US
Telephone Number	:	301-770-8700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SARA DEPEW
Credential	:	MD
Telephone Number	:	347-731-2133

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	11/27/2024

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