Basic Information
| Provider Information | |||||||||
| NPI: | 1710360227 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH CALVERT ANESTHESIOLOGY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 826699 | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191826699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103329500 | ||||||||
| FaxNumber: | 4103475599 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 SAINT PAUL ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212022123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103329000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2015 | ||||||||
| LastUpdateDate: | 07/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4103329500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.