Healthcare Provider Details

I. General information

NPI: 1073643870
Provider Name (Legal Business Name): ALLIANCE ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 POINT LOOKOUT RD
LEONARDTOWN MD
20650-2015
US

IV. Provider business mailing address

PO BOX 824339
PHILADELPHIA PA
19182-4339
US

V. Phone/Fax

Practice location:
  • Phone: 301-475-6204
  • Fax: 301-997-6507
Mailing address:
  • Phone: 302-709-4542
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateMD

VIII. Authorized Official

Name: THOMAS J FINKELSTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-475-6204