Healthcare Provider Details

I. General information

NPI: 1417951005
Provider Name (Legal Business Name): MATTHEW D ZINDER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GREENWOOD PLACE SUITE 300
PIKESVILLE NA
21208
UM

IV. Provider business mailing address

406 KINGS COLLEGE DRIVE
ARNOLD MD
21012
US

V. Phone/Fax

Practice location:
  • Phone: 410-580-0004
  • Fax: 410-580-0000
Mailing address:
  • Phone: 410-440-0312
  • Fax: 410-825-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR146704
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001176997
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0024166147
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: