Healthcare Provider Details

I. General information

NPI: 1013131960
Provider Name (Legal Business Name): MICHAEL W HOBAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

1219 CLEARFIELD CIR
LUTHERVILLE MD
21093-4707
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9375
  • Fax:
Mailing address:
  • Phone: 410-296-7714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR071677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: