Healthcare Provider Details

I. General information

NPI: 1568889327
Provider Name (Legal Business Name): BESTGATE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 BESTGATE RD STE 2B
ANNAPOLIS MD
21401-3404
US

IV. Provider business mailing address

820 BESTGATE RD STE 2B
ANNAPOLIS MD
21401-3404
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-2116
  • Fax: 410-224-2118
Mailing address:
  • Phone: 410-224-2116
  • Fax: 410-224-2118

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: MELISSA SUE BUSINSKY
Title or Position: REGISTERED AGENT
Credential:
Phone: 443-837-2101