Healthcare Provider Details

I. General information

NPI: 1720384431
Provider Name (Legal Business Name): MONTGOMERY ANESTHESIA CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 SHADY GROVE ROAD SUITE 200
ROCKVILLE MD
20850-6358
US

IV. Provider business mailing address

9420 KEY WEST AVE SUITE 202
ROCKVILLE MD
20850-3334
US

V. Phone/Fax

Practice location:
  • Phone: 301-340-8099
  • Fax: 301-340-8535
Mailing address:
  • Phone: 301-922-9666
  • Fax: 301-309-0765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM R STERN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-922-9666