MEDICARE: NORTHSTAR ANESTHESIA OF MARYLAND 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	:	1720977275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR ANESTHESIA OF MARYLAND LLC

Provider Business Mailing Address
First Line	:	6225 N STATE HIGHWAY 161 STE 200
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-2241
Country	:	US
Telephone Number	:	214-687-0001
Fax Number	:	817-856-0655

Provider Business Practice Location Address
First Line	:	10212 GOVERNOR LANE BLVD UNIT 1004
Second Line	:
City	:	WILLIAMSPORT
State	:	MD
Zip	:	21795-4088
Country	:	US
Telephone Number	:	301-733-4200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSHUA LEE LUMBLEY
Credential	:	MD
Telephone Number	:	214-687-0001

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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