Healthcare Provider Details

I. General information

NPI: 1356799977
Provider Name (Legal Business Name): METRO MARYLAND ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 THOMAS JOHNSON DR SUITE B/C
FREDERICK MD
21702-4742
US

IV. Provider business mailing address

PO BOX 9056
GAITHERSBURG MD
20898-9056
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-7000
  • Fax: 240-282-7558
Mailing address:
  • Phone: 301-695-7000
  • Fax: 240-282-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MOUSTAFA S AHMED
Title or Position: MD/MEMBER
Credential:
Phone: 301-695-7000