Healthcare Provider Details

I. General information

NPI: 1003316621
Provider Name (Legal Business Name): JARED LAMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 WILLOWBROOK RD
CUMBERLAND MD
21502-6393
US

IV. Provider business mailing address

14800 MCGILL DR SW
CUMBERLAND MD
21502-5863
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-7000
  • Fax:
Mailing address:
  • Phone: 301-707-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR204080
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: