Provider Demographics
NPI:1356799977
Name:METRO MARYLAND ANESTHESIA LLC
Entity type:Organization
Organization Name:METRO MARYLAND ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOUSTAFA
Authorized Official - Middle Name:S
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-695-7000
Mailing Address - Street 1:PO BOX 9056
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20898-9056
Mailing Address - Country:US
Mailing Address - Phone:301-695-7000
Mailing Address - Fax:240-282-7558
Practice Address - Street 1:165 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE B/C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4742
Practice Address - Country:US
Practice Address - Phone:301-695-7000
Practice Address - Fax:240-282-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty