Healthcare Provider Details

I. General information

NPI: 1366926214
Provider Name (Legal Business Name): OLIVER TAWIAH SR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5493
US

IV. Provider business mailing address

419 S MACON ST
BALTIMORE MD
21224-2630
US

V. Phone/Fax

Practice location:
  • Phone: 410-912-6397
  • Fax:
Mailing address:
  • Phone: 301-830-3766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024189586
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR190834
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: