Provider Demographics
NPI:1457433591
Name:WARREN H MACLEOD C R N A PA
Entity Type:Organization
Organization Name:WARREN H MACLEOD C R N A PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DULANEY
Authorized Official - Middle Name:ANESTHESIA
Authorized Official - Last Name:ASSOCIATES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:410-583-1000
Mailing Address - Street 1:901 DULANEY VALLEY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2600
Mailing Address - Country:US
Mailing Address - Phone:410-583-1000
Mailing Address - Fax:
Practice Address - Street 1:901 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2600
Practice Address - Country:US
Practice Address - Phone:410-583-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR051112367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417274-02OtherBC/BS OF MD BILLING #
MD213-52-9270OtherTRICARE BILLING #
MD235741OtherKAISER BILLING #
MHG9270001OtherBS FEDERAL BILLING #
MD536421300Medicaid
MD430022172OtherMEDICARE RR BILLING #
MHG9270001OtherBS FEDERAL BILLING #