Healthcare Provider Details

I. General information

NPI: 1891776852
Provider Name (Legal Business Name): ALFRED NICHOLSON BLOUNT JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CENTURY BLVD SUITE 480
GERMANTOWN MD
20874-1113
US

IV. Provider business mailing address

PO BOX 1510
GERMANTOWN MD
20875-1510
US

V. Phone/Fax

Practice location:
  • Phone: 301-515-4222
  • Fax: 301-515-4153
Mailing address:
  • Phone: 301-515-4222
  • Fax: 301-515-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN088820
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: