Provider Demographics
NPI:1093512287
Name:MOUNTAIN MARYLAND ANESTHESIA SERVICES LLC
Entity type:Organization
Organization Name:MOUNTAIN MARYLAND ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-522-0185
Mailing Address - Street 1:12252 WILLIAMS RD SE STE 103
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7988
Mailing Address - Country:US
Mailing Address - Phone:240-522-0185
Mailing Address - Fax:240-522-0186
Practice Address - Street 1:12252 WILLIAMS RD SE STE 103
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-7988
Practice Address - Country:US
Practice Address - Phone:240-522-0185
Practice Address - Fax:240-522-0186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGCENTER OF WESTERN MARYLAND, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty