Provider Demographics
NPI:1053934950
Name:MTC ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:MTC ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLOTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:410-258-4000
Mailing Address - Street 1:304 HEDGEPOCKET WAY
Mailing Address - Street 2:
Mailing Address - City:GLYNDON
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1816
Mailing Address - Country:US
Mailing Address - Phone:443-414-3580
Mailing Address - Fax:
Practice Address - Street 1:304 HEDGEPOCKET WAY
Practice Address - Street 2:
Practice Address - City:GLYNDON
Practice Address - State:MD
Practice Address - Zip Code:21136-1816
Practice Address - Country:US
Practice Address - Phone:443-414-3580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty