Healthcare Provider Details

I. General information

NPI: 1912330283
Provider Name (Legal Business Name): UPPER BAY ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CHESAPEAKE BLVD STE C
ELKTON MD
21921-6391
US

IV. Provider business mailing address

PO BOX 190
ELKTON MD
21922-0190
US

V. Phone/Fax

Practice location:
  • Phone: 443-245-3470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN CARLYLE
Title or Position: GENERAL PARTNER/RESIDENT AGENT
Credential:
Phone: 443-907-3089