Healthcare Provider Details

I. General information

NPI: 1528045820
Provider Name (Legal Business Name): MASSACHUSETTS AVENUE ANESTHESIA SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 GOLDSBORO RD SUITE 400
BETHESDA MD
20817-5826
US

IV. Provider business mailing address

6400 GOLDSBORO RD SUITE 400
BETHESDA MD
20817-5826
US

V. Phone/Fax

Practice location:
  • Phone: 301-263-0800
  • Fax: 301-263-0820
Mailing address:
  • Phone: 301-263-0800
  • Fax: 301-263-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO054682
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberDO054682
License Number StateMD

VIII. Authorized Official

Name: DR. MATTHEW S. WOLINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-263-0800