Healthcare Provider Details

I. General information

NPI: 1821233818
Provider Name (Legal Business Name): BALTIMORE ANESTHESIA ASSOCIATES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 S HANOVER ST
BALTIMORE MD
21230-4033
US

IV. Provider business mailing address

929 S HANOVER ST
BALTIMORE MD
21230-4033
US

V. Phone/Fax

Practice location:
  • Phone: 410-783-9019
  • Fax: 410-783-9019
Mailing address:
  • Phone: 410-783-9019
  • Fax: 410-783-9019

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: MR. CHRISTOPHER D ROBEL
Title or Position: PRESIDENT
Credential: CRNA, MSNA
Phone: 443-762-8471