Provider Demographics
NPI:1316068745
Name:CARDIAC ANESTHESIA ASSOCIATES, P.A.
Entity type:Organization
Organization Name:CARDIAC ANESTHESIA ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:410-337-5337
Mailing Address - Street 1:222 BOSLEY AVENUE
Mailing Address - Street 2:SUITE C6
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4399
Mailing Address - Country:US
Mailing Address - Phone:410-337-5337
Mailing Address - Fax:410-337-5338
Practice Address - Street 1:222 BOSLEY AVE
Practice Address - Street 2:SUITE C6
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4328
Practice Address - Country:US
Practice Address - Phone:410-337-5337
Practice Address - Fax:410-337-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCF4900OtherPALMETTO RAILROAD MCR
MD463521301Medicaid
MDE670OtherFEDERAL BLUE SHIELD
MDCF4900OtherPALMETTO RAILROAD MCR