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General NPI Number Information
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NPI Number | 1245400449
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Entity Type | Organization
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Legal Business Name | TAPAS ANESTHESIA SERVICE LLC.
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 2425 CUB HILL RD
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City | BALTIMORE
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State | MD
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Zip | 21234-1003
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Country | US
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Telephone | 410-663-5852
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 CUB HILL RD
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City | BALTIMORE
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State | MD
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Zip | 21234-1003
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Country | US
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Telephone | 410-663-5852
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS ALBERT PANNONE
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Credential | CRNA
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Telephone | 410-663-5852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | R053987
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License Number State | MD
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