Healthcare Provider Details

I. General information

NPI: 1538158977
Provider Name (Legal Business Name): CHEVY CHASE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 THOMAS JOHNSON DRIVE SUITE 207
FREDERICK MD
21070-4490
US

IV. Provider business mailing address

PO BOX 75737
BALTIMORE MD
21275-5737
US

V. Phone/Fax

Practice location:
  • Phone: 800-709-2705
  • Fax: 706-650-1034
Mailing address:
  • Phone: 800-709-2705
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW R. RIBAUDO
Title or Position: PRESIDENT
Credential:
Phone: 404-446-1417