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General NPI Number Information
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NPI Number | 1669866489
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Entity Type | Organization
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Legal Business Name | MID-MARYLAND ANESTHESIA LLC
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 04/25/2015
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Provider Practice Location Address
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Address Line | 85 THOMAS JOHNSON CT SUITE C
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City | FREDERICK
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State | MD
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Zip | 21702-4331
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Country | US
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Telephone | 301-663-9440
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Fax | 301-663-4602
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Provider Business Mailing Address
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Address Line | 85 THOMAS JOHNSON CT SUITE C
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City | FREDERICK
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State | MD
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Zip | 21702-4331
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Country | US
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Telephone | 301-663-9440
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Fax | 301-663-4602
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | LEONARD E KANE
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Credential | M.D.
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Telephone | 301-663-9440
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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 | D0061884
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License Number State | MD
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