Provider Demographics
NPI:1275776791
Name:ANESTHESIA SERVICES OF SOUTHERN MARYLAND PA
Entity Type:Organization
Organization Name:ANESTHESIA SERVICES OF SOUTHERN MARYLAND PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-427-1716
Mailing Address - Street 1:11855 HOLLY LANE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5801 ALLENTOWN RD
Practice Address - Street 2:SUITE 502
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746
Practice Address - Country:US
Practice Address - Phone:240-427-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD12966388174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty