Healthcare Provider Details

I. General information

NPI: 1851328884
Provider Name (Legal Business Name): MATTHEW RYAN D'ANGELO C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 64795
BALTIMORE MD
21264-4795
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6704
  • Fax: 410-328-4124
Mailing address:
  • Phone: 410-328-6704
  • Fax: 410-328-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR139212
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: