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General NPI Number Information
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NPI Number | 1396135182
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Entity Type | Organization
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Legal Business Name | PROVIDENCE ANESTHESIA ASSOCIATES, P.A.
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Dates
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Enumeration Date | 01/31/2015
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Last Update Date | 03/26/2016
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Provider Practice Location Address
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Address Line | 6911 LAUREL BOWIE RD SUITE 212
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City | BOWIE
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State | MD
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Zip | 20715-1712
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Country | US
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Telephone | 301-755-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 6911 LAUREL BOWIE RD SUITE 212
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City | BOWIE
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State | MD
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Zip | 20715-1712
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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 | DIRECTOR/PRESIDENT
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Name | JOSEPH M OPPONG JR.
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Credential | M.D.
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Telephone | 301-755-9500
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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 | MD039935
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D0066706
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License Number State | MD
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