Healthcare Provider Details

I. General information

NPI: 1720053887
Provider Name (Legal Business Name): CORRIDOR ANESTHESIA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD SUITE 230
LAUREL MD
20707-5263
US

IV. Provider business mailing address

7350 VAN DUSEN RD SUITE 250
LAUREL MD
20707-5263
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-5500
  • Fax: 301-498-7346
Mailing address:
  • Phone: 301-498-5500
  • Fax: 301-498-7346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. GEORGIA GALIE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 301-498-5500