Healthcare Provider Details

I. General information

NPI: 1215601703
Provider Name (Legal Business Name): MONTEZ CHARMARA BADGER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FOREST GLEN RD
SILVER SPRING MD
20910-1460
US

IV. Provider business mailing address

500 BAYLY RD
CAMBRIDGE MD
21613-2904
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number00241182482
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR187364
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: