Healthcare Provider Details

I. General information

NPI: 1336700160
Provider Name (Legal Business Name): NORTHRIUM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8222 SCHULTZ RD STE 100A
CLINTON MD
20735-2607
US

IV. Provider business mailing address

8222 SCHULTZ RD STE 100B
CLINTON MD
20735-2607
US

V. Phone/Fax

Practice location:
  • Phone: 202-221-8442
  • Fax: 202-221-8441
Mailing address:
  • Phone: 202-221-8442
  • Fax: 202-221-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS ADDISON
Title or Position: PRACTICE DIRECTOR
Credential:
Phone: 727-543-5064