Basic Information
| Provider Information | |||||||||
| NPI: | 1790283505 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANN MOOREHEAD ANESTHESIA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 BRIARCLIFF LN | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210145555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013170020 | ||||||||
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| Address1: | 125 BRIARCLIFF LN | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210145555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013170020 | ||||||||
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| ProviderEnumerationDate: | 01/26/2018 | ||||||||
| LastUpdateDate: | 01/31/2018 | ||||||||
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| AuthorizedOfficialLastName: | PATTON | ||||||||
| AuthorizedOfficialFirstName: | DAWN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SPVSR | ||||||||
| AuthorizedOfficialTelephone: | 3013170020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R089773 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.