Healthcare Provider Details

I. General information

NPI: 1245870674
Provider Name (Legal Business Name): NEAL THOMAS MARCELO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

13302 SPRINGWOOD CT
ELLICOTT CITY MD
21042-1256
US

V. Phone/Fax

Practice location:
  • Phone: 443-939-4526
  • Fax:
Mailing address:
  • Phone: 443-939-4526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR206579
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: