Healthcare Provider Details

I. General information

NPI: 1528578333
Provider Name (Legal Business Name): MEDSTAR MEDICAL GROUP ANESTHESIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

2000 15TH ST N STE 600
ARLINGTON VA
22201-2900
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-1403
  • Fax:
Mailing address:
  • Phone: 703-558-1403
  • Fax: 703-558-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE SCHNEIDER
Title or Position: VP
Credential:
Phone: 703-558-1403