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General NPI Number Information
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NPI Number | 1003989047
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Entity Type | Organization
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Legal Business Name | SLEEPWATCHERS INC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | THE PLASTIC SURGERY CENTER OF MARYLAND 1304 BELLONA AVENUE
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City | LUTHERVILLE
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State | MD
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Zip | 21093
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Country | US
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Telephone | 410-616-3000
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Fax | 410-616-2999
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Provider Business Mailing Address
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Address Line | 600 ANDREW HILL ROAD
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City | ARNOLD
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State | MD
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Zip | 21012
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Country | US
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Telephone | 443-621-8736
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Fax | 410-616-2999
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA LACIVITA
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Credential | CRNA
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Telephone | 443-621-8736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | R069690
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License Number State | MD
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