Basic Information
| Provider Information | |||||||||
| NPI: | 1528045820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MASSACHUSETTS AVENUE ANESTHESIA SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 GOLDSBORO RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208175826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012630800 | ||||||||
| FaxNumber: | 3012630820 | ||||||||
| Practice Location | |||||||||
| Address1: | 6400 GOLDSBORO RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208175826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012630800 | ||||||||
| FaxNumber: | 3012630820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 11/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | WOLINS | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3012630800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | DO054682 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207L00000X | DO054682 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.