Healthcare Provider Details

I. General information

NPI: 1295199925
Provider Name (Legal Business Name): WALDORF ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 OLD WASHINGTON RD STE 200
WALDORF MD
20602-3233
US

IV. Provider business mailing address

PO BOX 826894
PHILADELPHIA PA
19182-6894
US

V. Phone/Fax

Practice location:
  • Phone: 301-861-3660
  • Fax: 301-843-5184
Mailing address:
  • Phone: 941-360-1566
  • Fax: 941-358-9818

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: MR. JOSEPH R. MURPHY
Title or Position: MEMBER
Credential:
Phone: 941-360-1566