Provider Demographics
NPI:1073820478
Name:ELLICOTT CITY ANESTHESIA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ELLICOTT CITY ANESTHESIA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRIU
Authorized Official - Middle Name:FARROKH
Authorized Official - Last Name:ENGINEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-206-2180
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705-0610
Mailing Address - Country:US
Mailing Address - Phone:240-566-1600
Mailing Address - Fax:240-566-1605
Practice Address - Street 1:2850 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3464
Practice Address - Country:US
Practice Address - Phone:410-461-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical