Provider Demographics
NPI:1477585529
Name:UNIVERSITY OF MARYLAND ANESTHESIOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND ANESTHESIOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PROFESSIONAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLAYHART
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE, CPC
Authorized Official - Phone:410-328-6331
Mailing Address - Street 1:PO BOX 64374
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4374
Mailing Address - Country:US
Mailing Address - Phone:410-328-6331
Mailing Address - Fax:410-328-1674
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6331
Practice Address - Fax:410-328-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCA8702Medicare PIN
MDC15497Medicare PIN
MDC11298Medicare PIN
MDH595Medicare ID - Type UnspecifiedCRITICAL CARE GROUP NUM