Provider Demographics
NPI:1952784621
Name:ADVANTAGE ANESTHESIA OF MARYLAND LLC
Entity Type:Organization
Organization Name:ADVANTAGE ANESTHESIA OF MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-560-5089
Mailing Address - Street 1:12240 INDIAN CREEK CT
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12240 INDIAN CREEK CT
Practice Address - Street 2:SUITE 130
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1242
Practice Address - Country:US
Practice Address - Phone:240-560-5089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANTIA HOLDINGS OF MARYLAND LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-30
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC430462Medicare PIN