Provider Demographics
NPI:1689713935
Name:MEDSTAR HEALTH ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:MEDSTAR HEALTH ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-772-6595
Mailing Address - Street 1:5565 STERRETT PL
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5565 STERRETT PL
Practice Address - Street 2:5TH FLOOR
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2665
Practice Address - Country:US
Practice Address - Phone:410-772-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty