Healthcare Provider Details

I. General information

NPI: 1306636279
Provider Name (Legal Business Name): HOLY CROSS ANESTHESIOLOGY ASSOCIATE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8171 MAPLE LAWN BLVD STE 100
FULTON MD
20759-2527
US

IV. Provider business mailing address

PO BOX 64605
BALTIMORE MD
21264-4605
US

V. Phone/Fax

Practice location:
  • Phone: 410-531-7557
  • Fax: 410-531-0818
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHERRY PHILLPS
Title or Position: GROUP CONTACT
Credential:
Phone: 301-942-8799