Provider Demographics
NPI:1043052632
Name:MARYLAND ANESTHESIA & PAIN MANAGEMENT SERVICES, PC
Entity type:Organization
Organization Name:MARYLAND ANESTHESIA & PAIN MANAGEMENT SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL PE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:TIBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-985-7130
Mailing Address - Street 1:265 BROOKVIEW CENTRE WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4053
Mailing Address - Country:US
Mailing Address - Phone:865-985-7114
Mailing Address - Fax:
Practice Address - Street 1:515 S TOLLGATE RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5234
Practice Address - Country:US
Practice Address - Phone:443-643-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYLAND ANESTHESIA & PAIN MANAGEMENT SERVICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty