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General NPI Number Information
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NPI Number | 1275776791
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Entity Type | Organization
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Legal Business Name | ANESTHESIA SERVICES OF SOUTHERN MARYLAND PA
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 5801 ALLENTOWN RD SUITE 502
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City | CAMP SPRINGS
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State | MD
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Zip | 20746
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Country | US
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Telephone | 240-427-1760
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Fax |
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Provider Business Mailing Address
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Address Line | 11855 HOLLY LANE SUITE 101
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City | WALDORF
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State | MD
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Zip | 20601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACCOUNT COORDINATOR
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Name | MISS KRISTINA M COLE
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Credential |
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Telephone | 240-427-1716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D12966388
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License Number State | MD
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