Healthcare Provider Details

I. General information

NPI: 1538214242
Provider Name (Legal Business Name): FORT WASHINGTON ANESTHESIA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 LIVINGSTON ROAD
FORT WASHINGTON MD
20744
US

IV. Provider business mailing address

PO BOX 639
LAUREL MD
20725
US

V. Phone/Fax

Practice location:
  • Phone: 301-317-0020
  • Fax: 301-317-0028
Mailing address:
  • Phone: 301-317-0020
  • Fax: 301-317-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER R SMITH
Title or Position: PRESIDENT & CHAIRMAN MD
Credential: MD
Phone: 301-317-0020