Provider Demographics
NPI:1407964646
Name:BLUE RIDGE ANESTHESIA ASSOCIATES LLC
Entity Type:Organization
Organization Name:BLUE RIDGE ANESTHESIA ASSOCIATES LLC
Other - Org Name:BLUE RIDGE ANESTHESIA, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPARTMENT HEAD
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-665-1717
Mailing Address - Street 1:PO BOX 1248
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21741-1248
Mailing Address - Country:US
Mailing Address - Phone:301-665-1717
Mailing Address - Fax:301-665-1810
Practice Address - Street 1:11116 MEDICAL CAMPUS ROAD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6710
Practice Address - Country:US
Practice Address - Phone:301-665-1717
Practice Address - Fax:301-665-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207L00000X, 207LP2900X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD452002500Medicaid
PA0015906630005Medicaid
MD317LMedicare PIN