Basic Information
| Provider Information | |||||||||
| NPI: | 1598730251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOWARD COUNTY ANESTHESIA ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11085 LITTLE PATUXENT PKWY | ||||||||
| Address2: | SUITE 004 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107300099 | ||||||||
| FaxNumber: | 4109641345 | ||||||||
| Practice Location | |||||||||
| Address1: | 11085 LITTLE PATUXENT PKWY | ||||||||
| Address2: | SUITE 004 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107300099 | ||||||||
| FaxNumber: | 4109641345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | PAYNE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4107300099 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 912371700 | 05 | MD | MEDICAID |