Provider Demographics
NPI:1306388897
Name:MIDGARD ANESTHETICS LLC MATTHEW BELZAK SOLE MBR
Entity Type:Organization
Organization Name:MIDGARD ANESTHETICS LLC MATTHEW BELZAK SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELZAK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:703-862-5725
Mailing Address - Street 1:1050 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5303
Mailing Address - Country:US
Mailing Address - Phone:703-862-5725
Mailing Address - Fax:
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:800-222-1335
Practice Address - Fax:410-819-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC0001206149163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty