Provider Demographics
NPI:1366072605
Name:MLM ANESTHESIA LLC
Entity type:Organization
Organization Name:MLM ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-703-1111
Mailing Address - Street 1:305 WYE HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:QUEENSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21658-1638
Mailing Address - Country:US
Mailing Address - Phone:410-703-1111
Mailing Address - Fax:
Practice Address - Street 1:12205 TULLAMORE RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-7816
Practice Address - Country:US
Practice Address - Phone:410-308-4701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty