Healthcare Provider Details

I. General information

NPI: 1376501007
Provider Name (Legal Business Name): HOLY CROSS ANESTHESIOLOGY ASSOCIATE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BLACKBURN LN STE 220
BURTONSVILLE MD
20866-1104
US

IV. Provider business mailing address

PO BOX 64605
BALTIMORE MD
21264
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-8700
  • Fax:
Mailing address:
  • Phone: 301-933-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SARA DEPEW
Title or Position: PRESIDENT
Credential: MD
Phone: 347-731-2133