MEDICARE: SERENE SEDATION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	D43908	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D43908	OTHER	MD	MD LICENSE

General Provider Information

NPI Number	:	1023343373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENE SEDATION, LLC

Provider Business Mailing Address
First Line	:	9018 FAIRVIEW RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4105
Country	:	US
Telephone Number	:	301-704-3479
Fax Number	:

Provider Business Practice Location Address
First Line	:	9018 FAIRVIEW RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4105
Country	:	US
Telephone Number	:	301-704-3479
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DR. DAN LAWSON
Credential	:	MD
Telephone Number	:	301-704-3479

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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Directions to “SERENE SEDATION, LLC ” Practice Location

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