MEDICARE: MEDSTAR HEALTH ANESTHESIA SERVICES, 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

General Provider Information

NPI Number	:	1689713935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAR HEALTH ANESTHESIA SERVICES, LLC

Provider Business Mailing Address
First Line	:	5565 STERRETT PL
Second Line	:	5TH FLOOR
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5565 STERRETT PL
Second Line	:	5TH FLOOR
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2665
Country	:	US
Telephone Number	:	410-772-6595
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERIC R. WAGNER
Credential	:
Telephone Number	:	410-772-6595

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/22/2020

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