Provider Demographics
NPI:1053119602
Name:MJM ANESTHESIA ,LLC
Entity type:Organization
Organization Name:MJM ANESTHESIA ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-964-1160
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-0235
Mailing Address - Country:US
Mailing Address - Phone:202-413-6296
Mailing Address - Fax:
Practice Address - Street 1:223 7TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7045
Practice Address - Country:US
Practice Address - Phone:202-964-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty