Individual
GARY PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2411 W BELVEDERE AVE, MID ATLANTIC NEURO ASSOCIATES, BALTIMORE, MD 21215-5228
(410) 601-8314
Mailing address
10508 CHESHAM WAY, WOODSTOCK, MD 21163-1364
(410) 465-2449
(410) 465-2573
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R130008
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
649100600
—
MD
Enumeration date
08/11/2005
Last updated
11/26/2007
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