Healthcare Provider Details

I. General information

NPI: 1366703837
Provider Name (Legal Business Name): TRI-STATE ANESTESIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E PULASKI HWY
ELKTON MD
21922-6435
US

IV. Provider business mailing address

P.O.BOX 1040
ELKTON MD
21922-1040
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-0590
  • Fax:
Mailing address:
  • Phone: 410-398-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH MICHEL KNAPP
Title or Position: SOLE MEMBER
Credential: DO
Phone: 410-398-0590