Provider Demographics
NPI:1407027055
Name:C BOYD ANESTHESIA SERVICES, PC
Entity Type:Organization
Organization Name:C BOYD ANESTHESIA SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:LETITIA
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:410-799-5231
Mailing Address - Street 1:8190 TAMAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2894
Mailing Address - Country:US
Mailing Address - Phone:443-629-7430
Mailing Address - Fax:
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-602-7782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD369331700Medicaid
H9620001OtherBLUE CHOICE, FEDERAL
68733808OtherBLUE SHIELD
MD369331700Medicaid
MD92293Medicare UPIN