Healthcare Provider Details

I. General information

NPI: 1770823924
Provider Name (Legal Business Name): BRIAN M. TABOR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

6400 GOLDSBORO RD STE 400
BETHESDA MD
20817-5846
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7375
  • Fax: 954-851-1746
Mailing address:
  • Phone: 301-263-0800
  • Fax: 301-263-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR182389
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: