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General NPI Number Information
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NPI Number | 1689713935
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Entity Type | Organization
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Legal Business Name | MEDSTAR HEALTH ANESTHESIA SERVICES, LLC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5565 STERRETT PL 5TH FLOOR
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City | COLUMBIA
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State | MD
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Zip | 21044-2665
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Country | US
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Telephone | 410-772-6595
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Fax |
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Provider Business Mailing Address
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Address Line | 5565 STERRETT PL 5TH FLOOR
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City | COLUMBIA
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State | MD
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Zip | 21044-2665
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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 | PRESIDENT
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Name | MR. ERIC R. WAGNER
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Credential |
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Telephone | 410-772-6595
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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 |
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License Number State |
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