Provider Demographics
NPI:1770823924
Name:TABOR, BRIAN M (CRNA)
Entity Type:Individual
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First Name:BRIAN
Middle Name:M
Last Name:TABOR
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:6400 GOLDSBORO RD
Mailing Address - Street 2:STE 400
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5846
Mailing Address - Country:US
Mailing Address - Phone:301-263-0800
Mailing Address - Fax:301-263-0820
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-543-7375
Practice Address - Fax:954-851-1746
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2016-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR182389367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered