Healthcare Provider Details

I. General information

NPI: 1124832860
Provider Name (Legal Business Name): MJM ANESTHESIA SP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 M ST NW STE 401
WASHINGTON DC
20037-1449
US

IV. Provider business mailing address

PO BOX 235
CABIN JOHN MD
20818-0235
US

V. Phone/Fax

Practice location:
  • Phone: 202-964-1160
  • Fax:
Mailing address:
  • Phone: 202-413-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. HEATHER DAILEY
Title or Position: OWNER
Credential: CRNA
Phone: 202-413-6296