Healthcare Provider Details

I. General information

NPI: 1407027055
Provider Name (Legal Business Name): C BOYD ANESTHESIA SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 GREENE TREE RD SUITE 180
BALTIMORE MD
21208-6391
US

IV. Provider business mailing address

8190 TAMAR DR
COLUMBIA MD
21045-2894
US

V. Phone/Fax

Practice location:
  • Phone: 410-602-7782
  • Fax:
Mailing address:
  • Phone: 443-629-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA LETITIA BOYD
Title or Position: PRESIDENT
Credential: CRNA
Phone: 410-799-5231