Healthcare Provider Details

I. General information

NPI: 1033161286
Provider Name (Legal Business Name): AMERICAN ANESTHESIOLOGY OF MARYLAND, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST
TOWSON MD
21204
US

IV. Provider business mailing address

1122 KENILWORTH DR STE 317
TOWSON MD
21204-2146
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-4616
  • Fax: 410-337-5068
Mailing address:
  • Phone: 410-296-4616
  • Fax: 410-337-5068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateMD

VIII. Authorized Official

Name: MRS. ERICA BENSON
Title or Position: PRACTICE DIRECTOR
Credential:
Phone: 410-296-4616