Healthcare Provider Details

I. General information

NPI: 1144760760
Provider Name (Legal Business Name): MJM ANESTHESIA ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 MACARTHUR BLVD # 101-235
CABIN JOHN MD
20818-0235
US

IV. Provider business mailing address

7945 MACARTHUR BLVD #101-235
CABIN JOHN MD
20818-0235
US

V. Phone/Fax

Practice location:
  • Phone: 202-964-1160
  • Fax:
Mailing address:
  • Phone: 202-964-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR147286
License Number StateMD

VIII. Authorized Official

Name: HEATHER DAILEY
Title or Position: PRESIDENT
Credential: CRNA
Phone: 202-964-1160