Healthcare Provider Details

I. General information

NPI: 1699002451
Provider Name (Legal Business Name): MONICA C. DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2009
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANESTHESIOLOGY AND CRITICAL CARE MEDICINE 600 N. WOLFE STREET/ BLALOCK 1415
BALTIMORE MD
21287-0001
US

IV. Provider business mailing address

ANESTHESIOLOGY AND CRITICAL CARE MEDICINE 600 N. WOLFE STREET/ BLALOCK 1415
BALTIMORE MD
21287-0001
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8408
  • Fax: 410-955-4858
Mailing address:
  • Phone: 410-955-8408
  • Fax: 410-955-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR161917
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: