Provider Demographics
NPI:1275855637
Name:MERIDIAN ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:MERIDIAN ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:TORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-610-3608
Mailing Address - Street 1:7590 N FLINT HILL RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-4318
Mailing Address - Country:US
Mailing Address - Phone:410-610-3608
Mailing Address - Fax:
Practice Address - Street 1:11370 PEMBROOKE SQ
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4842
Practice Address - Country:US
Practice Address - Phone:410-610-3608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051726207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD976390200Medicaid
MD145N108GMedicare PIN
MD976390200Medicaid