=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477585529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF MARYLAND ANESTHESIOLOGY ASSOCIATES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 02/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 S GREENE ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21201-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-328-6331
-----------------------------------------------------
Fax | 410-328-1674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 64374
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21264-4374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-328-6331
-----------------------------------------------------
Fax | 410-328-1674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR PROFESSIONAL SERVICES
-----------------------------------------------------
Name | MRS. KIMBERLY R FLAYHART
-----------------------------------------------------
Credential | CMPE, CPC
-----------------------------------------------------
Telephone | 410-328-6331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------