Healthcare Provider Details

I. General information

NPI: 1710360227
Provider Name (Legal Business Name): NORTH CALVERT ANESTHESIOLOGY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SAINT PAUL ST
BALTIMORE MD
21202-2123
US

IV. Provider business mailing address

PO BOX 826699
PHILADELPHIA PA
19182-6699
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9000
  • Fax:
Mailing address:
  • Phone: 410-332-9500
  • Fax: 410-347-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WENDY HICKS
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 410-332-9500