Provider Demographics
NPI:1083093363
Name:RC ANESTHESIA LLC
Entity Type:Organization
Organization Name:RC ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REG MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-819-0710
Mailing Address - Street 1:29466 PINTAIL DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-9323
Mailing Address - Country:US
Mailing Address - Phone:410-819-0710
Mailing Address - Fax:410-819-0712
Practice Address - Street 1:29466 PINTAIL DR
Practice Address - Street 2:SUITE 8
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-9323
Practice Address - Country:US
Practice Address - Phone:410-819-0710
Practice Address - Fax:410-819-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR126336367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404998500Medicaid
MDBX43-0000OtherCAREFIRST OF MARYLAND