Organization
PENN MAR ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY THOMAS HAUGH M.D. (PRESIDENT)
(301) 685-3555
Entity
Organization
Contact information
Practice address
11110 MEDICAL CAMPUS RD, SUITE 228, HAGERSTOWN, MD 21742-6700
(301) 733-0022
Mailing address
PO BOX 931, HARPERS FERRY, WV 25425-0931
(410) 819-0710
(410) 819-0712
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D0037485
MD
207L00000X
Anesthesiology Physician
MD060826L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
412508800
—
MD
01
—
420P
MARYLAND MEDICARE GROUP
MD
01
—
DF7236
RR MEDICARE
MD
Enumeration date
05/22/2006
Last updated
06/28/2016
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