Provider Demographics
NPI:1457506248
Name:ATILLO, ERWIN SUMILLER (MSN - CRNA)
Entity Type:Individual
Prefix:MR
First Name:ERWIN
Middle Name:SUMILLER
Last Name:ATILLO
Suffix:
Gender:M
Credentials:MSN - CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353A LOUDON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5636
Mailing Address - Country:US
Mailing Address - Phone:240-841-9038
Mailing Address - Fax:
Practice Address - Street 1:5855 BREMO ROAD SUITE 100 N.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-288-6258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160082367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419435700Medicaid
MD419435700Medicaid