Healthcare Provider Details

I. General information

NPI: 1891286597
Provider Name (Legal Business Name): ENDOSEDATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 ANNAPOLIS RD STE 220
GLENN DALE MD
20769-9182
US

IV. Provider business mailing address

12200 ANNAPOLIS RD STE 220
GLENN DALE MD
20769-9182
US

V. Phone/Fax

Practice location:
  • Phone: 240-491-2344
  • Fax: 301-699-2293
Mailing address:
  • Phone: 240-491-2344
  • Fax: 301-699-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL H. BLAIR
Title or Position: CEO
Credential:
Phone: 240-491-2344