Healthcare Provider Details

I. General information

NPI: 1245400449
Provider Name (Legal Business Name): TAPAS ANESTHESIA SERVICE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 CUB HILL RD
BALTIMORE MD
21234-1003
US

IV. Provider business mailing address

2425 CUB HILL RD
BALTIMORE MD
21234-1003
US

V. Phone/Fax

Practice location:
  • Phone: 410-663-5852
  • Fax:
Mailing address:
  • Phone: 410-663-5852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR053987
License Number StateMD

VIII. Authorized Official

Name: MR. THOMAS ALBERT PANNONE
Title or Position: PRESIDENT
Credential: CRNA
Phone: 410-663-5852